Provider Demographics
NPI:1205095999
Name:ADIGHIBE, ANDREA (MOT,OTR/L, CHT)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:ADIGHIBE
Suffix:
Gender:F
Credentials:MOT,OTR/L, CHT
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:EBIYUN
Other - Last Name:PIRI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1226 S CANAL ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-5213
Practice Address - Country:US
Practice Address - Phone:312-733-8958
Practice Address - Fax:312-733-9447
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
MI5201007895225X00000X
OHOH.007016225X00000X
IL056008362225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216859029Medicare PIN
IL211585045Medicare PIN
IL202845060Medicare PIN