Provider Demographics
NPI:1508102161
Name:ANDREWS, JOLEEN ANTONIA (OT/L)
Entity Type:Individual
Prefix:MRS
First Name:JOLEEN
Middle Name:ANTONIA
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 DIAMOND SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-2481
Mailing Address - Country:US
Mailing Address - Phone:336-624-2937
Mailing Address - Fax:
Practice Address - Street 1:3504 DIAMOND SPRINGS DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-2481
Practice Address - Country:US
Practice Address - Phone:336-624-2937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5447225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist