Provider Demographics
NPI:1124895461
Name:BREAUX, ANDREA (COTA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BREAUX
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5422 CARPENTER AVE
Mailing Address - Street 2:
Mailing Address - City:BUZZARDS BAY
Mailing Address - State:MA
Mailing Address - Zip Code:02542-1507
Mailing Address - Country:US
Mailing Address - Phone:210-480-4279
Mailing Address - Fax:
Practice Address - Street 1:5422 CARPENTER AVE
Practice Address - Street 2:
Practice Address - City:BUZZARDS BAY
Practice Address - State:MA
Practice Address - Zip Code:02542-1507
Practice Address - Country:US
Practice Address - Phone:210-480-4279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4937224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant