Provider Demographics
NPI:1801101076
Name:WOODS, ANDREA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:WOODS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:MULLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17330 PRESTON RD
Mailing Address - Street 2:STE 150A
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5997
Mailing Address - Country:US
Mailing Address - Phone:972-248-4994
Mailing Address - Fax:
Practice Address - Street 1:17330 PRESTON RD
Practice Address - Street 2:STE 150A
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5997
Practice Address - Country:US
Practice Address - Phone:972-248-4994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00500800225X00000X
PAOC010990225X00000X
NY015420-1225X00000X
TX114888225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist