Provider Demographics
NPI:1407554421
Name:KINGAN, ANDREW (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:KINGAN
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 WATER ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-2307
Mailing Address - Country:US
Mailing Address - Phone:724-602-8394
Mailing Address - Fax:
Practice Address - Street 1:205 WATER ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2307
Practice Address - Country:US
Practice Address - Phone:724-602-8394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist