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General NPI Number Information
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NPI Number | 1013191428
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Entity Type | Individual
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Provider Name | SUSAN E. ANDRE O.T.R.
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Gender | Female
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Dates
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Enumeration Date | 12/20/2007
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 4843 COLLEYVILLE BLVD STE 221
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City | COLLEYVILLE
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State | TX
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Zip | 76034-3986
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Country | US
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Telephone | 972-979-6577
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Fax | 972-979-6951
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Provider Business Mailing Address
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Address Line | 790 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4909
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Country | US
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Telephone | 866-370-8206
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XH1200X
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Taxonomy Name | Hand Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 105821
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License Number State | TX
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