Provider Demographics
NPI:1225016629
Name:BRITTEN, ANDREA N (MA OTR)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:N
Last Name:BRITTEN
Suffix:
Gender:F
Credentials:MA OTR
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 12686
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97309-0686
Mailing Address - Country:US
Mailing Address - Phone:503-540-8701
Mailing Address - Fax:503-371-8772
Practice Address - Street 1:4677 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302
Practice Address - Country:US
Practice Address - Phone:503-585-5131
Practice Address - Fax:503-858-4065
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1071057225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR275415Medicaid
385622Medicare ID - Type Unspecified