Provider Demographics
NPI:1922318534
Name:VEACH, ANDREA MAE (NCTM)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MAE
Last Name:VEACH
Suffix:
Gender:F
Credentials:NCTM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-2801
Mailing Address - Country:US
Mailing Address - Phone:701-741-7922
Mailing Address - Fax:
Practice Address - Street 1:1108 N 16TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-2801
Practice Address - Country:US
Practice Address - Phone:701-741-7922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1011225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist