Healthcare Provider Details

I. General information

NPI: 1922317932
Provider Name (Legal Business Name): ANDREA MARIE HORGAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA SNIDER

II. Dates (important events)

Enumeration Date: 09/26/2010
Last Update Date: 09/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 THURBERS AVE #220A
PROVIDENCE RI
02905-4754
US

IV. Provider business mailing address

630 SMITHFIELD RD APT 314
NORTH PROVIDENCE RI
02904-2900
US

V. Phone/Fax

Practice location:
  • Phone: 401-270-9991
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT01250
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: