Provider Demographics
NPI:1083102685
Name:O'BRIEN, ANDREA M (OTR/L, CLT)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:M
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:OTR/L, CLT
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:MICHELLE
Other - Last Name:MADDUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:4504 STARLITE LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-1725
Mailing Address - Country:US
Mailing Address - Phone:502-930-6064
Mailing Address - Fax:
Practice Address - Street 1:4504 STARLITE LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-1725
Practice Address - Country:US
Practice Address - Phone:502-930-6064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-29
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY225XP0200X, 225XE0001X, 225XF0002X, 225XG0600X, 225XN1300X
225XP0019X
KY132611225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation