Healthcare Provider Details

I. General information

NPI: 1417860578
Provider Name (Legal Business Name): ANDREW PERRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 WEST ST
COLUMBIA CT
06237-1340
US

IV. Provider business mailing address

128 WEST ST
COLUMBIA CT
06237-1340
US

V. Phone/Fax

Practice location:
  • Phone: 860-617-3513
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: