Provider Demographics
NPI:1407196249
Name:ANDRESEN, NATASHA E (OTR/L)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:E
Last Name:ANDRESEN
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 1:5455 KUAMOO RD
Mailing Address - Street 2:UNIT D
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-8117
Mailing Address - Country:US
Mailing Address - Phone:517-442-4612
Mailing Address - Fax:
Practice Address - Street 1:5455 KUAMOO RD
Practice Address - Street 2:UNIT D
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-8117
Practice Address - Country:US
Practice Address - Phone:517-442-4612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-14
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1212225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist