Provider Demographics
NPI:1760003875
Name:HOUTRAS, ANDRID
Entity Type:Individual
Prefix:
First Name:ANDRID
Middle Name:
Last Name:HOUTRAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08620-2910
Mailing Address - Country:US
Mailing Address - Phone:609-658-3875
Mailing Address - Fax:
Practice Address - Street 1:207 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08620-2910
Practice Address - Country:US
Practice Address - Phone:609-658-3875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00291400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ46TR00291400OtherCERTIFIED AND LICENSED OCCUPATIONAL THERAPIST