Healthcare Provider Details

I. General information

NPI: 1891153185
Provider Name (Legal Business Name): ANNE AMENDOLA OT/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 MAMARONECK AVE STE 412
HARRISON NY
10528-2430
US

IV. Provider business mailing address

7 4TH ST APT 4J
STAMFORD CT
06905-5025
US

V. Phone/Fax

Practice location:
  • Phone: 914-686-3116
  • Fax:
Mailing address:
  • Phone: 914-588-0107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: