MEDICARE: ANDREA WASHINGTON OT

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	225X00000X	Occupational Therapist	5201005037	MI

General Provider Information

NPI Number	:	1790102648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA WASHINGTON OT

Provider Business Mailing Address
First Line	:	33900 HARPER AVE
Second Line	:	SUITE 104
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48035
Country	:	US
Telephone Number	:	586-416-9100
Fax Number	:	586-416-9103

Provider Business Practice Location Address
First Line	:	5141 OAKMAN BLVD
Second Line	:	SUITE D
City	:	DEARBORN
State	:	MI
Zip	:	48126-3763
Country	:	US
Telephone Number	:	313-359-8200
Fax Number	:	313-228-0330

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

Provider Enumeration Date	:	03/27/2014
Last Update Date	:	03/27/2014

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Directions to “ ANDREA WASHINGTON OT” Practice Location

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