Provider Demographics
NPI:1558766592
Name:MENIN, ANDREA (OT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MENIN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 PINE CREST PL
Mailing Address - Street 2:
Mailing Address - City:MANSON
Mailing Address - State:WA
Mailing Address - Zip Code:98831-9664
Mailing Address - Country:US
Mailing Address - Phone:206-310-3183
Mailing Address - Fax:
Practice Address - Street 1:325 PINE CREST PL
Practice Address - Street 2:
Practice Address - City:MANSON
Practice Address - State:WA
Practice Address - Zip Code:98831-9664
Practice Address - Country:US
Practice Address - Phone:206-310-3183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60497874225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics