Provider Demographics
NPI:1588846497
Name:ANDRES, TODD MATTHEW (OT)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:MATTHEW
Last Name:ANDRES
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 CIRCLE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5568
Mailing Address - Country:US
Mailing Address - Phone:920-497-1515
Mailing Address - Fax:920-497-1513
Practice Address - Street 1:1050 CIRCLE DR
Practice Address - Street 2:SUITE B
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5568
Practice Address - Country:US
Practice Address - Phone:920-497-1515
Practice Address - Fax:920-497-1513
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2768-026225XE1200X
WI2768-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics