Provider Demographics
NPI:1457600389
Name:EATON-WHITLEY, ANDREA MARIE
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MARIE
Last Name:EATON-WHITLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51
Mailing Address - Street 2:2413 TREWIGTOWN RD.
Mailing Address - City:COLMAR
Mailing Address - State:PA
Mailing Address - Zip Code:18915-0051
Mailing Address - Country:US
Mailing Address - Phone:508-561-8803
Mailing Address - Fax:
Practice Address - Street 1:2738 FISCHER RD
Practice Address - Street 2:
Practice Address - City:HATFIELD
Practice Address - State:PA
Practice Address - Zip Code:19440-2899
Practice Address - Country:US
Practice Address - Phone:215-412-2090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG003323225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist