Provider Demographics
NPI:1154651701
Name:CHAMPLIN, ANDREA MARIE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MARIE
Last Name:CHAMPLIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:SPEGAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:11044 CEDARBERRY PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-7252
Mailing Address - Country:US
Mailing Address - Phone:314-625-7596
Mailing Address - Fax:
Practice Address - Street 1:11044 CEDARBERRY PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-7252
Practice Address - Country:US
Practice Address - Phone:314-625-7596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008021473225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist