Provider Demographics
NPI:1285863589
Name:DELPH, ANDREA GERALDINE (OTR)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:GERALDINE
Last Name:DELPH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:ANDREA
Other - Middle Name:GERALDINE
Other - Last Name:DELPH-PRINCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2565 12TH SQ SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-5065
Mailing Address - Country:US
Mailing Address - Phone:321-301-0938
Mailing Address - Fax:
Practice Address - Street 1:2565 12TH SQ SW
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32968-5065
Practice Address - Country:US
Practice Address - Phone:321-301-0938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11837225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890478200Medicaid