Provider Demographics
NPI:1265003057
Name:ANDRADE, FEB DENISE BASA (OTR/L)
Entity Type:Individual
Prefix:
First Name:FEB DENISE
Middle Name:BASA
Last Name:ANDRADE
Suffix:
Gender:F
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 1:2685 UNIVERSITY AVE APT 23A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-3358
Mailing Address - Country:US
Mailing Address - Phone:347-961-4498
Mailing Address - Fax:
Practice Address - Street 1:2685 UNIVERSITY AVE APT 23A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-3358
Practice Address - Country:US
Practice Address - Phone:347-961-4498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025784225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist