Healthcare Provider Details

I. General information

NPI: 1073488912
Provider Name (Legal Business Name): ANDREA EFTHEMIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 DIVISION ST
NORTH TONAWANDA NY
14120-4464
US

IV. Provider business mailing address

3572 KELSEY LN
NORTH TONAWANDA NY
14120-3614
US

V. Phone/Fax

Practice location:
  • Phone: 716-692-1049
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number030360
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: