Provider Demographics
NPI:1003295338
Name:MOORMANN, ANDREA JEAN (MOT)
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:JEAN
Last Name:MOORMANN
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9132 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1393
Mailing Address - Country:US
Mailing Address - Phone:630-532-3915
Mailing Address - Fax:
Practice Address - Street 1:15300 WEST AVE
Practice Address - Street 2:WEST BLDG., SUITE 310
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4600
Practice Address - Country:US
Practice Address - Phone:708-349-3388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.010933225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist