Provider Demographics
NPI:1679749162
Name:BILLUPS, ANDREA EUNICE (COTA/L)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:EUNICE
Last Name:BILLUPS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4136 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60478-5151
Mailing Address - Country:US
Mailing Address - Phone:708-774-2550
Mailing Address - Fax:708-991-2727
Practice Address - Street 1:4136 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:COUNTRY CLUB HILLS
Practice Address - State:IL
Practice Address - Zip Code:60478-5151
Practice Address - Country:US
Practice Address - Phone:708-774-2550
Practice Address - Fax:708-991-2727
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.001634172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker