Provider Demographics
NPI:1235700923
Name:DEMING, ANDREA RAE (CTRS, LRT)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:RAE
Last Name:DEMING
Suffix:
Gender:F
Credentials:CTRS, LRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 MILE HIGH LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-8718
Mailing Address - Country:US
Mailing Address - Phone:469-438-3933
Mailing Address - Fax:
Practice Address - Street 1:1136 MILE HIGH LAKE RD
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694-8718
Practice Address - Country:US
Practice Address - Phone:469-438-3933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4222225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist