Provider Demographics
NPI:1366893943
Name:DULWORTH, ANDREA NICHOLE (OTR)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:NICHOLE
Last Name:DULWORTH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8331 TERRA VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-5598
Mailing Address - Country:US
Mailing Address - Phone:281-536-2650
Mailing Address - Fax:
Practice Address - Street 1:903 LONGMIRE RD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1817
Practice Address - Country:US
Practice Address - Phone:281-536-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113479225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist