Basic Information
| Provider Information | |||||||||
| NPI: | 1164942454 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALBRECHT | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | ROSS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1511 LINCOLN DR | ||||||||
| Address2: | |||||||||
| City: | WEST BEND | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2623659983 | ||||||||
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| Practice Location | |||||||||
| Address1: | W76 N677 WAUWATOSA RD | ||||||||
| Address2: | |||||||||
| City: | CEDARBURG | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2623775060 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2017 | ||||||||
| LastUpdateDate: | 06/27/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.