Provider Demographics
NPI:1134415466
Name:MIES, ANDRA L (COTA)
Entity type:Individual
Prefix:MS
First Name:ANDRA
Middle Name:L
Last Name:MIES
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 1:610 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3618
Mailing Address - Country:US
Mailing Address - Phone:316-440-1600
Mailing Address - Fax:316-440-1675
Practice Address - Street 1:610 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-3601
Practice Address - Country:US
Practice Address - Phone:316-440-1600
Practice Address - Fax:316-440-1675
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00764224ZL0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantLow Vision