Provider Demographics
NPI:1114294410
Name:ANDERSON, CAROLYN JEANNE (OTR)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JEANNE
Last Name:ANDERSON
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 1:70 MEADOW HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-2926
Mailing Address - Country:US
Mailing Address - Phone:845-564-9666
Mailing Address - Fax:
Practice Address - Street 1:175 ROUTE 32 N
Practice Address - Street 2:ULSTER COUNTY BOCES
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1029
Practice Address - Country:US
Practice Address - Phone:845-255-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0032331225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics