Provider Demographics
NPI:1245468388
Name:LEVINGER, ANDREA STAR (OTR/L)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:STAR
Last Name:LEVINGER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:STAR
Other - Last Name:PHELAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:390 1ST AVE APT 3E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4938
Mailing Address - Country:US
Mailing Address - Phone:212-677-7132
Mailing Address - Fax:
Practice Address - Street 1:390 1ST AVE APT 3E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4938
Practice Address - Country:US
Practice Address - Phone:212-677-7132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-28
Last Update Date:2009-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010162174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010162OtherNEW YORK STATE OCCUPATIONAL THERAPY LICENSE