Provider Demographics
NPI:1790209187
Name:WOODS, ANDREA (ATC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:WOODS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:ALLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:124 OAK CREST DR
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65706-8203
Mailing Address - Country:US
Mailing Address - Phone:816-309-2973
Mailing Address - Fax:
Practice Address - Street 1:900 N BENTON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-3712
Practice Address - Country:US
Practice Address - Phone:417-873-6865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170259852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer