Provider Demographics
NPI:1093552796
Name:PRASIL, ANDREA JADEN (OTR/L)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:JADEN
Last Name:PRASIL
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 1:8285 SW NIMBUS AVE STE 174
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-6447
Mailing Address - Country:US
Mailing Address - Phone:503-579-7327
Mailing Address - Fax:
Practice Address - Street 1:8285 SW NIMBUS AVE STE 174
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-6447
Practice Address - Country:US
Practice Address - Phone:503-579-7327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR510731225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist