Healthcare Provider Details

I. General information

NPI: 1134382096
Provider Name (Legal Business Name): INDEPENDENCE THERAPY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 INDIAN ROCK RD STE 11
WINDHAM NH
03087-1691
US

IV. Provider business mailing address

25 INDIAN ROCK RD STE 11
WINDHAM NH
03087-1691
US

V. Phone/Fax

Practice location:
  • Phone: 603-952-4560
  • Fax: 603-952-4561
Mailing address:
  • Phone: 603-952-4560
  • Fax: 603-952-4561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JOHN P MORAN
Title or Position: OWNER
Credential:
Phone: 603-952-4560