Provider Demographics
NPI:1093741951
Name:HAIN, ANDREA J (MOTR L)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:J
Last Name:HAIN
Suffix:
Gender:F
Credentials:MOTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 CACHE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-6388
Mailing Address - Country:US
Mailing Address - Phone:501-519-1324
Mailing Address - Fax:501-519-1324
Practice Address - Street 1:2400 WILLOW ST
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-2212
Practice Address - Country:US
Practice Address - Phone:501-519-1324
Practice Address - Fax:501-519-1324
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1484225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR141099721Medicaid