Healthcare Provider Details

I. General information

NPI: 1588871016
Provider Name (Legal Business Name): SANDRA A O'CONNOR PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

573 GRANBY RD
SOUTH HADLEY MA
01075-2122
US

IV. Provider business mailing address

202 HAMPDEN RD
STAFFORD SPRINGS CT
06076-3123
US

V. Phone/Fax

Practice location:
  • Phone: 413-532-2200
  • Fax:
Mailing address:
  • Phone: 860-684-7243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number331
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: