Provider Demographics
NPI:1225016629
Name:BURRESS, ANDREA N (MA OTR)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:N
Last Name:BURRESS
Suffix:
Gender:F
Credentials:MA OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 619
Mailing Address - Street 2:
Mailing Address - City:DONALD
Mailing Address - State:OR
Mailing Address - Zip Code:97020-0619
Mailing Address - Country:US
Mailing Address - Phone:503-508-5468
Mailing Address - Fax:971-983-5211
Practice Address - Street 1:1475 MOUNT HOOD AVE
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-9099
Practice Address - Country:US
Practice Address - Phone:971-983-5206
Practice Address - Fax:971-983-5211
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1071057225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR275415Medicaid
385622Medicare ID - Type Unspecified