Provider Demographics
NPI:1639578750
Name:ANDERSON, MARGARET THERESA (COTA/L)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:THERESA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6666 COUNTY ROUTE 11
Mailing Address - Street 2:BABCOCK HOLLOW OFFICE CENTER SUITE 4
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810
Mailing Address - Country:US
Mailing Address - Phone:607-776-9800
Mailing Address - Fax:
Practice Address - Street 1:6666 COUNTY ROUTE 11
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-7773
Practice Address - Country:US
Practice Address - Phone:607-776-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000321-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant