Provider Demographics
NPI:1588871016
Name:O'CONNOR, SANDRA A (PTA)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:A
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 HAMPDEN RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD SPRINGS
Mailing Address - State:CT
Mailing Address - Zip Code:06076-3123
Mailing Address - Country:US
Mailing Address - Phone:860-684-7243
Mailing Address - Fax:
Practice Address - Street 1:573 GRANBY RD
Practice Address - Street 2:
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-2122
Practice Address - Country:US
Practice Address - Phone:413-532-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA331313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility