Provider Demographics
NPI:1215026240
Name:CHEATHAM, ANDREA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:CHEATHAM
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 1:1779 2ND AVE
Mailing Address - Street 2:APT. 12C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3613
Mailing Address - Country:US
Mailing Address - Phone:917-414-5075
Mailing Address - Fax:
Practice Address - Street 1:1779 2ND AVE
Practice Address - Street 2:APT. 12C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3613
Practice Address - Country:US
Practice Address - Phone:917-414-5075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012653-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist