Provider Demographics
NPI:1427521319
Name:SNOW, ANDREW RICHARD (OTR/L)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:RICHARD
Last Name:SNOW
Suffix:
Gender:M
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 1:31 FOX HILL LN
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3815
Mailing Address - Country:US
Mailing Address - Phone:916-412-5482
Mailing Address - Fax:
Practice Address - Street 1:35 HOLY FAMILY RD # 2701
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2701
Practice Address - Country:US
Practice Address - Phone:413-532-3246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA426151225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist