Provider Demographics
NPI:1497183586
Name:NEARY, ANDREW (MT-BC, NMT-FELLOW)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:NEARY
Suffix:
Gender:M
Credentials:MT-BC, NMT-FELLOW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 E EDEN PL
Mailing Address - Street 2:
Mailing Address - City:ST FRANCIS
Mailing Address - State:WI
Mailing Address - Zip Code:53235-3749
Mailing Address - Country:US
Mailing Address - Phone:970-531-9639
Mailing Address - Fax:
Practice Address - Street 1:2308 E EDEN PL
Practice Address - Street 2:
Practice Address - City:ST FRANCIS
Practice Address - State:WI
Practice Address - Zip Code:53235-3749
Practice Address - Country:US
Practice Address - Phone:970-531-9639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI08574225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist