Provider Demographics
NPI:1811217342
Name:SPLETSTOSER, ANDREA ELIZABETH (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:ELIZABETH
Last Name:SPLETSTOSER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:ELIZABETH
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7540 N 19TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-7967
Mailing Address - Country:US
Mailing Address - Phone:503-530-0632
Mailing Address - Fax:
Practice Address - Street 1:7540 N 19TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-7967
Practice Address - Country:US
Practice Address - Phone:503-530-0632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24212174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist