Andrea Lauren Mardis, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OT-A1504 Issued in AR

Practice address

2220 S Waldron Rd
Fort Smith, AR 72903-3733

Phone

(479) 434-2009

NPI assigned

Jul 16, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597190400000",
    "number": "1184277469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6130 BREWSTER CHAPEL RD",
            "city": "HUNTINGTON",
            "state": "AR",
            "postal_code": "729409119",
            "telephone_number": "479-739-8246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2220 S WALDRON RD",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729033733",
            "telephone_number": "479-434-2009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARDIS",
        "first_name": "ANDREA",
        "middle_name": "LAUREN",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-16",
        "last_updated": "2020-08-12",
        "certification_date": "2020-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "AR",
            "license": "OT-A1504",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen C Manus, MD
• Julia Marchese
• Marcie McKinney D.D.S., P.a.
• Stephanie R Marcom, FNP-C
• Whitney Brannon Marcotte, M.S., CCC-SLP
• Margaret J Thiele DDS PA
• Arthur Basil Marino, OTR
• Mark a Willis DDS Ms PA
• Allison Marker, DO
• Kathleen Ann Marks-Henderson

• Occupational Therapy Assistant in Fort Smith, AR
• Providers in Fort Smith, AR by specialty
• Occupational Therapy Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.