Provider Demographics
NPI:1568730398
Name:CALDWELL, ANDREA LEE (OT/L)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LEE
Last Name:CALDWELL
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 1:1355 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-2022
Mailing Address - Country:US
Mailing Address - Phone:360-794-4011
Mailing Address - Fax:360-794-9477
Practice Address - Street 1:1355 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2022
Practice Address - Country:US
Practice Address - Phone:360-794-4011
Practice Address - Fax:360-794-9477
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002041314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility