Basic Information
| Provider Information | |||||||||
| NPI: | 1003295338 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOORMANN | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | M.O.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9132 WINDSOR DR | ||||||||
| Address2: | |||||||||
| City: | PALOS HILLS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604651393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305323915 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 15300 WEST AVE | ||||||||
| Address2: | WEST BLDG., SUITE 310 | ||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604624600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083493388 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2015 | ||||||||
| LastUpdateDate: | 05/19/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 056.010933 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.