Provider Demographics
NPI:1689074064
Name:LOCHOW, ANDREW (RBT, BAS)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:LOCHOW
Suffix:
Gender:M
Credentials:RBT, BAS
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:P
Other - Last Name:LOCHOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9051 FLORIDA MINING BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-1240
Mailing Address - Country:US
Mailing Address - Phone:813-374-2070
Mailing Address - Fax:813-337-0937
Practice Address - Street 1:9051 FLORIDA MINING BLVD STE 102
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-1240
Practice Address - Country:US
Practice Address - Phone:813-374-2070
Practice Address - Fax:813-337-0937
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-1615621106S00000X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician