Provider Demographics
NPI:1700098720
Name:MOROGE, ANDREA MARIE (MED, OTR/L)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:MOROGE
Suffix:
Gender:F
Credentials:MED, OTR/L
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1940 S BONITO WAY STE 190
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5618
Mailing Address - Country:US
Mailing Address - Phone:208-287-9420
Mailing Address - Fax:
Practice Address - Street 1:895 E STATE ST
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6003
Practice Address - Country:US
Practice Address - Phone:208-860-6229
Practice Address - Fax:208-287-9426
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7776225XP0200X
IDOT-640225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8084437Medicaid