Provider Demographics
NPI:1679057624
Name:DRUM, ANDREA VICTORIA (LMT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:VICTORIA
Last Name:DRUM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 NE 38TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-2303
Mailing Address - Country:US
Mailing Address - Phone:816-807-9486
Mailing Address - Fax:
Practice Address - Street 1:106 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1640
Practice Address - Country:US
Practice Address - Phone:816-807-9486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-15
Last Update Date:2018-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014041503225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist