Provider Demographics
NPI:1588219463
Name:HOM, ANDY (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:HOM
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 1:485 MADISON AVE FL 8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5803
Mailing Address - Country:US
Mailing Address - Phone:212-980-2963
Mailing Address - Fax:646-858-1858
Practice Address - Street 1:485 MADISON AVE FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5803
Practice Address - Country:US
Practice Address - Phone:212-980-2963
Practice Address - Fax:646-858-1858
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023814225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist