Provider Demographics
NPI:1053551440
Name:ODIAN, ANDREA ELIZABETH (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:ELIZABETH
Last Name:ODIAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:ELIZABETH
Other - Last Name:MARGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:99 MULFORD RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07821
Mailing Address - Country:US
Mailing Address - Phone:973-383-6200
Mailing Address - Fax:
Practice Address - Street 1:99 MULFORD RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:NJ
Practice Address - Zip Code:07821-2600
Practice Address - Country:US
Practice Address - Phone:973-383-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012020225X00000X
NJ46TR00534600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist