Provider Demographics
NPI:1063548303
Name:STANLEY, ANDREA (OTR/L)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1796 WINK AVE
Mailing Address - Street 2:
Mailing Address - City:PANORA
Mailing Address - State:IA
Mailing Address - Zip Code:50216-8509
Mailing Address - Country:US
Mailing Address - Phone:308-380-9982
Mailing Address - Fax:
Practice Address - Street 1:1796 WINK AVE
Practice Address - Street 2:
Practice Address - City:PANORA
Practice Address - State:IA
Practice Address - Zip Code:50216-8509
Practice Address - Country:US
Practice Address - Phone:308-380-9982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-02372225X00000X
NE1314225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist