Healthcare Provider Details

I. General information

NPI: 1558749556
Provider Name (Legal Business Name): PATRICIA ALICE ANDERSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS PATRICIA ALICE WIGHT

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 CREAMERY RD
GREENVILLE NY
12083-2130
US

IV. Provider business mailing address

351 CREAMERY RD
GREENVILLE NY
12083-2130
US

V. Phone/Fax

Practice location:
  • Phone: 518-312-9278
  • Fax:
Mailing address:
  • Phone: 518-312-9278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number004281-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number004281-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number004281-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number004281-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: