Provider Demographics
NPI:1720752595
Name:ANDERSON, DESIREE LEA (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:LEA
Last Name:ANDERSON
Suffix:
Gender:
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:LEA
Other - Last Name:BODZIONY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 N CRANBERRY RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6305
Mailing Address - Country:US
Mailing Address - Phone:410-739-4405
Mailing Address - Fax:
Practice Address - Street 1:3421 MARTHA BUSH DR
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4426
Practice Address - Country:US
Practice Address - Phone:410-465-1352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09323225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist