Provider Demographics
NPI:1891035580
Name:LEWIS, ANDREA LINDSAY (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LINDSAY
Last Name:LEWIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4280 HICKORY FLAT HWY
Mailing Address - Street 2:STE 108
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-6633
Mailing Address - Country:US
Mailing Address - Phone:770-345-2804
Mailing Address - Fax:770-783-5049
Practice Address - Street 1:4280 HICKORY FLAT HWY
Practice Address - Street 2:STE 108
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-6633
Practice Address - Country:US
Practice Address - Phone:770-345-2804
Practice Address - Fax:770-783-5049
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005581225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics