Provider Demographics
NPI:1932545969
Name:LADOWSKI, ANDREA JO (MSOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:JO
Last Name:LADOWSKI
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:JO
Other - Last Name:NIETOPSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOTR/L
Mailing Address - Street 1:191 PAMLICO LN
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5957
Mailing Address - Country:US
Mailing Address - Phone:704-577-6296
Mailing Address - Fax:
Practice Address - Street 1:191 PAMLICO LN
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5957
Practice Address - Country:US
Practice Address - Phone:704-577-6296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2781171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor