Provider Demographics
NPI:1538442801
Name:SANDERSON, EILEEN (OTR)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1071
Mailing Address - Street 2:
Mailing Address - City:PHILMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12565-8071
Mailing Address - Country:US
Mailing Address - Phone:917-482-1099
Mailing Address - Fax:
Practice Address - Street 1:810 COUNTY ROUTE 217
Practice Address - Street 2:
Practice Address - City:MELLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12544
Practice Address - Country:US
Practice Address - Phone:917-482-1099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002190-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist