Provider Demographics
NPI:1679817282
Name:ANDRADE, MIRIAM F (COTA)
Entity Type:Individual
Prefix:MISS
First Name:MIRIAM
Middle Name:F
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 DOBSON ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1600
Mailing Address - Country:US
Mailing Address - Phone:203-260-3236
Mailing Address - Fax:
Practice Address - Street 1:30 DOBSON ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1600
Practice Address - Country:US
Practice Address - Phone:203-260-3236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000850224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant