Provider Demographics
NPI:1003515362
Name:BENDER, ANDREA M (OTA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:BENDER
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5536 OLD PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-4078
Mailing Address - Country:US
Mailing Address - Phone:330-780-5353
Mailing Address - Fax:
Practice Address - Street 1:3800 POPLAR HILL RD STE B
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5522
Practice Address - Country:US
Practice Address - Phone:757-776-3088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121002728224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0121002728OtherBOARD OF MEDICINE LICENSE NUMBER