Provider Demographics
NPI:1588934160
Name:ANDROS, ANGELA ELIZABETH (OT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:ELIZABETH
Last Name:ANDROS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:ELIZABETH
Other - Last Name:ANDROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:800-944-9782
Mailing Address - Fax:610-438-2024
Practice Address - Street 1:833 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2431
Practice Address - Country:US
Practice Address - Phone:810-229-9190
Practice Address - Fax:810-229-7721
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006038225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist