Provider Demographics
NPI:1427302868
Name:ANDERSON, AMY JANEL (OTR/L)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JANEL
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 TOMPKINS AVE
Mailing Address - Street 2:APT #2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-6583
Mailing Address - Country:US
Mailing Address - Phone:352-246-1958
Mailing Address - Fax:
Practice Address - Street 1:571 EAST NEW YORK AVE
Practice Address - Street 2:OFFICE B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225
Practice Address - Country:US
Practice Address - Phone:347-663-9027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0174711225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics