Provider Demographics
NPI:1770186553
Name:NOSICH, ANDREA ELIZABETH (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:ELIZABETH
Last Name:NOSICH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ANDY
Other - Middle Name:ELIZABETH
Other - Last Name:NOSICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:690 E 113TH PL
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7162
Mailing Address - Country:US
Mailing Address - Phone:219-765-5482
Mailing Address - Fax:
Practice Address - Street 1:690 E 113TH PL
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7162
Practice Address - Country:US
Practice Address - Phone:219-765-5482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31007295A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist