Healthcare Provider Details

I. General information

NPI: 1083760920
Provider Name (Legal Business Name): CYNTHIA L ANDERSON B.S., OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 FISHERS STATION DR SUITE 130
VICTOR NY
14564-9744
US

IV. Provider business mailing address

590 FISHERS STATION DR SUITE 130
VICTOR NY
14564-9744
US

V. Phone/Fax

Practice location:
  • Phone: 585-924-7207
  • Fax: 585-924-7049
Mailing address:
  • Phone: 585-924-7207
  • Fax: 585-924-7049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number000802-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number000802-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: