Provider Demographics
NPI:1861510034
Name:CALVARESE, ANDREA MARIKKA (COTA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIKKA
Last Name:CALVARESE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-6018
Mailing Address - Country:US
Mailing Address - Phone:302-367-5114
Mailing Address - Fax:
Practice Address - Street 1:810 S BROOM ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-4245
Practice Address - Country:US
Practice Address - Phone:302-652-1181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU20000988224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant