Provider Demographics
NPI:1891093639
Name:DIXON, ANDREA MARY (OTR/L)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:MARY
Last Name:DIXON
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 1:833 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-3663
Mailing Address - Country:US
Mailing Address - Phone:248-227-4556
Mailing Address - Fax:586-270-0162
Practice Address - Street 1:833 MILLER RD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-3663
Practice Address - Country:US
Practice Address - Phone:248-227-4556
Practice Address - Fax:586-270-0162
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006102225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist