Provider Demographics
NPI:1659308732
Name:OETTING, WILLIAM ANDREW (PT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ANDREW
Last Name:OETTING
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LOUIS DR
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-3122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 EDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5211
Practice Address - Country:US
Practice Address - Phone:203-302-3570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002631225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTANC866OtherOXFORD ORTHONET PROVIDER
CT080002631CT01OtherANTHEM BCBS PROVIDER #
CT65000266Medicare ID - Type UnspecifiedPROVIDER NUMBER