Provider Demographics
NPI:1003070509
Name:ENGLERT, ANDREA KOREN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:KOREN
Last Name:ENGLERT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9006 CANVASBACK CIR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-5275
Mailing Address - Country:US
Mailing Address - Phone:804-840-2532
Mailing Address - Fax:804-748-0428
Practice Address - Street 1:9006 CANVASBACK CIR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23838-5275
Practice Address - Country:US
Practice Address - Phone:804-840-2532
Practice Address - Fax:804-748-0428
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001293225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA053020656049Medicaid