Provider Demographics
NPI:1427564004
Name:ANDRES, SHANA MICHELLE (OTR)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:MICHELLE
Last Name:ANDRES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9871 BANET RD
Mailing Address - Street 2:
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-8720
Mailing Address - Country:US
Mailing Address - Phone:502-322-6560
Mailing Address - Fax:
Practice Address - Street 1:3626 GRANT LINE RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2298
Practice Address - Country:US
Practice Address - Phone:502-561-4295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17-1005225X00000X
OR392972225X00000X
KY244816225X00000X
IN31007068A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist