Provider Demographics
NPI:1578778684
Name:DANDREA, ERIN M (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:M
Last Name:DANDREA
Suffix:
Gender:F
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 1:1104 LITCHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SABATTUS
Mailing Address - State:ME
Mailing Address - Zip Code:04280-4327
Mailing Address - Country:US
Mailing Address - Phone:207-577-5960
Mailing Address - Fax:
Practice Address - Street 1:1104 LITCHFIELD RD
Practice Address - Street 2:
Practice Address - City:SABATTUS
Practice Address - State:ME
Practice Address - Zip Code:04280-4327
Practice Address - Country:US
Practice Address - Phone:207-577-5960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1510174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME195250000Medicaid
ME043625Medicare UPIN