Healthcare Provider Details

I. General information

NPI: 1679140446
Provider Name (Legal Business Name): ANDREA M FREY MSOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 MAIN ST STE 311
PLYMOUTH NH
03264-1500
US

IV. Provider business mailing address

27 WEEKS DR
ORFORD NH
03777-4621
US

V. Phone/Fax

Practice location:
  • Phone: 603-481-0055
  • Fax:
Mailing address:
  • Phone: 603-443-0546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2930
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: