Provider Demographics
NPI:1790456481
Name:ESTEVEZ, ANDRES ADONIS (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:ADONIS
Last Name:ESTEVEZ
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 1:10214 RADCLIFF AVE APT 4R
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-5075
Mailing Address - Country:US
Mailing Address - Phone:347-475-2013
Mailing Address - Fax:
Practice Address - Street 1:10214 RADCLIFF AVE APT 4R
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-5075
Practice Address - Country:US
Practice Address - Phone:347-475-2013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025956225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty