Provider Demographics
NPI:1255624615
Name:BURROW, ANDREA JOY (OTR)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:JOY
Last Name:BURROW
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 CENTURY PLAZA RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5476
Mailing Address - Country:US
Mailing Address - Phone:317-216-2434
Mailing Address - Fax:
Practice Address - Street 1:4850 CENTURY PLAZA RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5476
Practice Address - Country:US
Practice Address - Phone:317-216-2434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002807A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist