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General NPI Number Information
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NPI Number | 1023994720
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Entity Type | Individual
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Provider Name | SHENA NICOLE RADAM ANDAYA OTD, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/15/2025
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 2550 MORTHLAND DR
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City | VALPARAISO
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State | IN
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Zip | 46385-6704
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Country | US
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Telephone | 219-309-2550
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Fax |
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Provider Business Mailing Address
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Address Line | 6419 OLD PORTER RD
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City | PORTAGE
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State | IN
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Zip | 46368-1604
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Country | US
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Telephone | 219-413-6298
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 31008803A
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License Number State | IN
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