Provider Demographics
NPI:1316558331
Name:ANDREAS, NEVIN JOHN (OT)
Entity Type:Individual
Prefix:
First Name:NEVIN
Middle Name:JOHN
Last Name:ANDREAS
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 FLYNN DR STE 3
Mailing Address - Street 2:
Mailing Address - City:MILBANK
Mailing Address - State:SD
Mailing Address - Zip Code:57252-1509
Mailing Address - Country:US
Mailing Address - Phone:605-432-3173
Mailing Address - Fax:
Practice Address - Street 1:301 FLYNN DR STE 3
Practice Address - Street 2:
Practice Address - City:MILBANK
Practice Address - State:SD
Practice Address - Zip Code:57252-1509
Practice Address - Country:US
Practice Address - Phone:605-432-3173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD05642255A2300X
MN106299225X00000X
SD1178225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer