Active NPI
Andrea Reeves Vandervort, OTR
- Pediatric Occupational Therapist
- Roswell, GA
National Provider Identifier
1881103711
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 006718
- Practice address
- 2910 Roxburgh Dr
Roswell, GA 30076-2427 - Phone
- (901) 896-9754
- NPI assigned
- Sep 22, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Rehabilitation Occupational Therapist | 225XP0019X | 006718 | ||
| Pediatric Occupational Therapist | 225XP0200X | 006718 | GA | Primary |
Addresses
Primary practice location
2910 Roxburgh Dr
Roswell, GA 30076-2427
Mailing address
2910 Roxburgh Dr
Roswell, GA 30076-2427
Phone (901) 896-9754
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 006718 | Other | GA | OCCUPATIONAL THERAPY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 006718 | GA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506038400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1881103711",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2910 ROXBURGH DR",
"city": "ROSWELL",
"state": "GA",
"postal_code": "300762427",
"telephone_number": "901-896-9754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2910 ROXBURGH DR",
"city": "ROSWELL",
"state": "GA",
"postal_code": "300762427",
"telephone_number": "901-896-9754"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDERVORT",
"first_name": "ANDREA",
"middle_name": "REEVES",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-22",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0019X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Physical Rehabilitation",
"state": null,
"license": "006718",
"primary": false
},
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "GA",
"license": "006718",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OCCUPATIONAL THERAPY",
"identifier": "006718",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roswell, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.