Healthcare Provider Details

I. General information

NPI: 1427302868
Provider Name (Legal Business Name): AMY JANEL ANDERSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 EAST NEW YORK AVE OFFICE B
BROOKLYN NY
11225
US

IV. Provider business mailing address

131 TOMPKINS AVE APT #2
BROOKLYN NY
11206-6583
US

V. Phone/Fax

Practice location:
  • Phone: 347-663-9027
  • Fax:
Mailing address:
  • Phone: 352-246-1958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0174711
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: