Provider Demographics
NPI:1528441284
Name:WHITE, ANDREA MARIE (OYR/L)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:WHITE
Suffix:
Gender:F
Credentials:OYR/L
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MARIE
Other - Last Name:ISKRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:804 11TH ST W
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-4830
Mailing Address - Country:US
Mailing Address - Phone:602-789-1075
Mailing Address - Fax:
Practice Address - Street 1:804 11TH ST W
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-4830
Practice Address - Country:US
Practice Address - Phone:602-789-1075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1331225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist