Provider Demographics
NPI:1912098799
Name:STEVENS, ANDREW BRANDT (ORT/L)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:BRANDT
Last Name:STEVENS
Suffix:
Gender:M
Credentials:ORT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 OSLO CIR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-5965
Mailing Address - Country:US
Mailing Address - Phone:205-944-3921
Mailing Address - Fax:205-413-4914
Practice Address - Street 1:120 OSLO CIR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-5965
Practice Address - Country:US
Practice Address - Phone:205-944-3921
Practice Address - Fax:205-413-4914
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2502225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890017300Medicaid
AL51534727OtherBCBS
AL890017300Medicaid