Provider Demographics
NPI:1831456771
Name:BUSSMAN, ANDREW (OT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:BUSSMAN
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2488 E 81ST ST STE 290
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4265
Mailing Address - Country:US
Mailing Address - Phone:918-927-3737
Mailing Address - Fax:918-927-3193
Practice Address - Street 1:524 W IOLA ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-2564
Practice Address - Country:US
Practice Address - Phone:918-994-5333
Practice Address - Fax:918-994-5334
Is Sole Proprietor?:No
Enumeration Date:2012-04-17
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XH1200X
OK1777225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200569700AMedicaid