Provider Demographics
NPI:1003669755
Name:CONNOR, ANDRIA LEIGH (COTA/L)
Entity Type:Individual
Prefix:
First Name:ANDRIA
Middle Name:LEIGH
Last Name:CONNOR
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:ANDRIA
Other - Middle Name:LEIGH
Other - Last Name:HERD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:3820 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:MI
Mailing Address - Zip Code:48455-9714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3820 VALLEY DR
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:MI
Practice Address - Zip Code:48455-9714
Practice Address - Country:US
Practice Address - Phone:904-947-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202008061224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant