Provider Demographics
NPI:1427460021
Name:ANDERSON, ANANDI COURTNEY (OT, LMT)
Entity type:Individual
Prefix:
First Name:ANANDI
Middle Name:COURTNEY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OT, LMT
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:ANDERSON
Other - Last Name:EARL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT, LMT
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:WILLSBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12996-0023
Mailing Address - Country:US
Mailing Address - Phone:518-528-9958
Mailing Address - Fax:
Practice Address - Street 1:2885 ESSEX RD
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:NY
Practice Address - Zip Code:12936-2317
Practice Address - Country:US
Practice Address - Phone:518-528-9958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-30
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018647225700000X
NY010698225X00000X
VT072.0091394225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist