Provider Demographics
NPI:1073248894
Name:PIETERS, ANDREA LAUREN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:LAUREN
Last Name:PIETERS
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 1:21 GREEN PINE LN
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-8963
Mailing Address - Country:US
Mailing Address - Phone:585-750-8991
Mailing Address - Fax:
Practice Address - Street 1:402 ROGERS PKWY
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-4738
Practice Address - Country:US
Practice Address - Phone:585-957-7158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026339225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist