Provider Demographics
NPI:1386861441
Name:MCANDREW, ROSE LOUISE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:LOUISE
Last Name:MCANDREW
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:LOUISE
Other - Last Name:DUNPHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:
Practice Address - Street 1:2937 S BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-2713
Practice Address - Country:US
Practice Address - Phone:314-761-3804
Practice Address - Fax:314-961-1147
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007117225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619980OtherBCBS OF IL
IL600000Medicare PIN
MO990701511Medicare PIN
IL600040Medicare PIN
ILK53519Medicare PIN
IL1619980OtherBCBS OF IL
MO990701509Medicare PIN
ILK53520Medicare PIN
ILK18606Medicare PIN