MEDICARE: MRS. ANDREA MARIE O'CONNOR PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	008913-1	NY

General Provider Information

NPI Number	:	1093092918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA MARIE O'CONNOR PT

Provider Business Mailing Address
First Line	:	472 GRIGGS PL
Second Line	:
City	:	EAST AURORA
State	:	NY
Zip	:	14052-2908
Country	:	US
Telephone Number	:	716-652-6987
Fax Number	:

Provider Business Practice Location Address
First Line	:	3150 SCHOOLVIEW RD
Second Line	:
City	:	EDEN
State	:	NY
Zip	:	14057-1107
Country	:	US
Telephone Number	:	716-992-3645
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2011
Last Update Date	:	11/06/2011

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