Provider Demographics
NPI:1194058560
Name:VERUCCI, ANDREA M (COTA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:VERUCCI
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 E MAIN ST
Mailing Address - Street 2:SUITE 132
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7333
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:280 E MAIN ST
Practice Address - Street 2:SUITE 132
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7333
Practice Address - Country:US
Practice Address - Phone:302-709-0440
Practice Address - Fax:302-709-0443
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU20001079224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant