Provider Demographics
NPI:1457576902
Name:ABDELAHAD, SANDRA A (OTR, CHT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:A
Last Name:ABDELAHAD
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PINE NEEDLE RD
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:MA
Mailing Address - Zip Code:01756-1329
Mailing Address - Country:US
Mailing Address - Phone:508-634-5404
Mailing Address - Fax:508-634-5404
Practice Address - Street 1:12 PINE NEEDLE RD
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:MA
Practice Address - Zip Code:01756-1329
Practice Address - Country:US
Practice Address - Phone:508-634-5404
Practice Address - Fax:508-634-5404
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA001225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6917560001Medicare NSC
MAAB-Y69730Medicare ID - Type Unspecified