Provider Demographics
NPI:1538368253
Name:HANDORF, DEANNA LYNN (MHS, OTRL)
Entity type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:LYNN
Last Name:HANDORF
Suffix:
Gender:F
Credentials:MHS, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5072 STELLAR RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-1665
Mailing Address - Country:US
Mailing Address - Phone:586-295-1696
Mailing Address - Fax:
Practice Address - Street 1:11900 SHIRE BLVD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48095-1710
Practice Address - Country:US
Practice Address - Phone:586-207-4460
Practice Address - Fax:586-416-8440
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI977055 REGISTRATION225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1538368253OtherMEDICARE
MI977055Medicaid