Provider Demographics
NPI:1821523424
Name:LANG, ANDREW (OTRL)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:LANG
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:
Other - Last Name:LANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTRL
Mailing Address - Street 1:312 KIRKSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSCOMMON
Mailing Address - State:MI
Mailing Address - Zip Code:48653-9221
Mailing Address - Country:US
Mailing Address - Phone:586-441-2222
Mailing Address - Fax:
Practice Address - Street 1:312 KIRKSHIRE AVE
Practice Address - Street 2:
Practice Address - City:ROSCOMMON
Practice Address - State:MI
Practice Address - Zip Code:48653-9221
Practice Address - Country:US
Practice Address - Phone:989-846-4521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009526225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist