Provider Demographics
NPI:1336434349
Name:CROSSON, ANDREA L (OTR)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:CROSSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23500 US HIGHWAY 160
Mailing Address - Street 2:
Mailing Address - City:WALSENBURG
Mailing Address - State:CO
Mailing Address - Zip Code:81089-9524
Mailing Address - Country:US
Mailing Address - Phone:719-738-5100
Mailing Address - Fax:
Practice Address - Street 1:23500 US HIGHWAY 160
Practice Address - Street 2:
Practice Address - City:WALSENBURG
Practice Address - State:CO
Practice Address - Zip Code:81089-9524
Practice Address - Country:US
Practice Address - Phone:719-738-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0001303225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist