Provider Demographics
NPI:1265014237
Name:KOESTER, ANDREA (MSOT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:KOESTER
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-1624
Mailing Address - Country:US
Mailing Address - Phone:314-598-7591
Mailing Address - Fax:
Practice Address - Street 1:507 DOGWOOD LN
Practice Address - Street 2:
Practice Address - City:CARTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62918-1624
Practice Address - Country:US
Practice Address - Phone:314-598-7591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.009340225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist