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General NPI Number Information
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NPI Number | 1417441601
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Entity Type | Individual
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Provider Name | ANDERSTON ST GERMAIN OT
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Gender | Male
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 9900 W SAMPLE RD STE 102
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-4008
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Country | US
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Telephone | 954-341-7875
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Fax | 954-341-7895
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Provider Business Mailing Address
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Address Line | 6620 SW 20TH ST
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City | PLANTATION
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State | FL
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Zip | 33317-5105
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Country | US
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Telephone | 305-528-0474
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT11946
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License Number State | FL
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