Provider Demographics
NPI:1356593453
Name:ANDRADE, TINA RENEE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:RENEE
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 SHAKESPEARE DR
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-2167
Mailing Address - Country:US
Mailing Address - Phone:215-256-6117
Mailing Address - Fax:
Practice Address - Street 1:600 W VALLEY FORGE RD
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1571
Practice Address - Country:US
Practice Address - Phone:610-337-1775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC005260L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist