MEDICARE: MRS. MANDY LEE DILLINGER OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	112617	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	112617	OTHER	TX	OT LICENSE

General Provider Information

NPI Number	:	1548219744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MANDY LEE DILLINGER OTR/L

Provider Business Mailing Address
First Line	:	11222 WHISPER FALLS ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-3538
Country	:	US
Telephone Number	:	210-592-7635
Fax Number	:

Provider Business Practice Location Address
First Line	:	11222 WHISPER FALLS ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-3538
Country	:	US
Telephone Number	:	210-592-7635
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	10/16/2008

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