Provider Demographics
NPI:1871360966
Name:WURSTER, ANDREA (OTR/L)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:WURSTER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ANDI
Other - Middle Name:
Other - Last Name:WURSTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1907 Q ST UNIT 417
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-6855
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4987 GOLDEN FOOTHILL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9364
Practice Address - Country:US
Practice Address - Phone:916-365-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT472273225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist