Provider Demographics
NPI:1699912303
Name:ANDREW, JOHN (OTR/L)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:ANDREW
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 1:17 THE OLD RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1520
Mailing Address - Country:US
Mailing Address - Phone:203-300-1112
Mailing Address - Fax:203-364-9010
Practice Address - Street 1:5674 MOSHOLU AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2411
Practice Address - Country:US
Practice Address - Phone:203-300-1112
Practice Address - Fax:203-364-9010
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010103-1225XP0200X
CT003153225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics