MEDICARE: ANANDI COURTNEY ANDERSON OT, LMT

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	225700000X	Massage Therapist	018647	NY
2	225X00000X	Occupational Therapist	010698	NY
3	225X00000X	Occupational Therapist	072.0091394	VT

General Provider Information

NPI Number	:	1427460021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANANDI COURTNEY ANDERSON OT, LMT

Provider Business Mailing Address
First Line	:	PO BOX 23
Second Line	:
City	:	WILLSBORO
State	:	NY
Zip	:	12996-0023
Country	:	US
Telephone Number	:	518-528-9958
Fax Number	:

Provider Business Practice Location Address
First Line	:	2885 ESSEX RD
Second Line	:
City	:	ESSEX
State	:	NY
Zip	:	12936-2317
Country	:	US
Telephone Number	:	518-528-9958
Fax Number	:

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

Provider Enumeration Date	:	05/30/2014
Last Update Date	:	05/30/2014

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