Provider Demographics
NPI:1720277908
Name:OSIKA, ANDREW (ATC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:OSIKA
Suffix:
Gender:M
Credentials:ATC
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 2008
Mailing Address - Street 2:
Mailing Address - City:ORANGE BEACH
Mailing Address - State:AL
Mailing Address - Zip Code:36561-2008
Mailing Address - Country:US
Mailing Address - Phone:251-981-4408
Mailing Address - Fax:251-217-9304
Practice Address - Street 1:3751 BLUE HERON DR
Practice Address - Street 2:
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542-2787
Practice Address - Country:US
Practice Address - Phone:251-981-4408
Practice Address - Fax:251-217-9304
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer