Active NPI
Al DG Mandeoya Grande, OTRL
- Occupational Therapist
- Wyandotte, MI
National Provider Identifier
1093064941
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 5201008599
- Practice address
- 2333 Biddle Ave
Wyandotte, MI 48192 - Phone
- (734) 246-7732
- NPI assigned
- Sep 6, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 5201008599 | MI | Primary |
Addresses
Primary practice location
2333 Biddle Ave
Wyandotte, MI 48192
Mailing address
28053 Weddel Ave
Brownstown TWP, MI 48183-4841
Phone (734) 341-5391
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5201008599 | MI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530057600000",
"number": "1093064941",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28053 WEDDEL AVE",
"city": "BROWNSTOWN TWP",
"state": "MI",
"postal_code": "481834841",
"telephone_number": "734-341-5391"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2333 BIDDLE AVE",
"city": "WYANDOTTE",
"state": "MI",
"postal_code": "48192",
"telephone_number": "734-246-7732"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANDE",
"first_name": "AL DG",
"middle_name": "MANDEOYA",
"name_prefix": "Mr.",
"credential": "OTRL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-09-06",
"last_updated": "2018-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "5201008599",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wyandotte, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.