Provider Demographics
NPI:1447386990
Name:MISTLER, ANDREA L (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:L
Last Name:MISTLER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 GARDEN PATH
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-3706
Mailing Address - Country:US
Mailing Address - Phone:631-589-2987
Mailing Address - Fax:
Practice Address - Street 1:7 GARDEN PATH
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-3706
Practice Address - Country:US
Practice Address - Phone:631-589-2987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005843-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics