Provider Demographics
NPI:1396907242
Name:FARRELL, ANDREA J (COTA/L)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:FARRELL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9492 N 300 W
Mailing Address - Street 2:
Mailing Address - City:PERRYSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47974-8141
Mailing Address - Country:US
Mailing Address - Phone:217-304-2732
Mailing Address - Fax:
Practice Address - Street 1:400 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CHRISMAN
Practice Address - State:IL
Practice Address - Zip Code:61924-1042
Practice Address - Country:US
Practice Address - Phone:217-269-2105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057002230224Z00000X
IN32001051A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant