Provider Demographics
NPI:1164819223
Name:ALSUM, ANDRENNE
Entity Type:Individual
Prefix:
First Name:ANDRENNE
Middle Name:
Last Name:ALSUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7858 SHRADER RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4222
Mailing Address - Country:US
Mailing Address - Phone:804-270-1305
Mailing Address - Fax:804-273-9294
Practice Address - Street 1:7858 SHRADER RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-4222
Practice Address - Country:US
Practice Address - Phone:804-270-1305
Practice Address - Fax:804-273-9294
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006559225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist