Healthcare Provider Details

I. General information

NPI: 1891190914
Provider Name (Legal Business Name): SHELLY ANDREWS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2014
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 WAUKEGAN RD
GLENVIEW IL
60025-3070
US

IV. Provider business mailing address

11769 W 124TH AVE
CEDAR LAKE IN
46303-8070
US

V. Phone/Fax

Practice location:
  • Phone: 877-486-4140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31008541A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056010808
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: