Provider Demographics
NPI:1386048981
Name:SANDRA ANN ABDELAHAD
Entity type:Organization
Organization Name:SANDRA ANN ABDELAHAD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELAHAD
Authorized Official - Suffix:
Authorized Official - Credentials:OTR, CHT
Authorized Official - Phone:508-634-5404
Mailing Address - Street 1:12 PINE NEEDLE RD
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:MA
Mailing Address - Zip Code:01756-1329
Mailing Address - Country:US
Mailing Address - Phone:508-634-5404
Mailing Address - Fax:508-634-5404
Practice Address - Street 1:12 PINE NEEDLE RD
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:MA
Practice Address - Zip Code:01756-1329
Practice Address - Country:US
Practice Address - Phone:508-634-5404
Practice Address - Fax:508-634-5404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-10
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA001225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6917560001Medicare NSC