Provider Demographics
NPI:1124379847
Name:PICKLES, ANDREA (OTR/L, RD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:PICKLES
Suffix:
Gender:F
Credentials:OTR/L, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 NATHAN PL NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2351
Mailing Address - Country:US
Mailing Address - Phone:607-368-8113
Mailing Address - Fax:
Practice Address - Street 1:8315 TURNING LEAF LN
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-2615
Practice Address - Country:US
Practice Address - Phone:703-288-0620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005203225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist