Provider Demographics
NPI:1558657056
Name:MASHALA, ANDREW M (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:M
Last Name:MASHALA
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56836 MEADOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-5838
Mailing Address - Country:US
Mailing Address - Phone:574-215-3396
Mailing Address - Fax:574-293-9908
Practice Address - Street 1:56836 MEADOWOOD DR
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-5838
Practice Address - Country:US
Practice Address - Phone:574-215-3396
Practice Address - Fax:574-293-9908
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002483A225X00000X
MI5201007685225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist