Provider Demographics
NPI:1649370354
Name:ANDERSON, NANCY O (MS,OTR/L)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:O
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 SAGAMORE RD
Mailing Address - Street 2:
Mailing Address - City:SAGAMORE BEACH
Mailing Address - State:MA
Mailing Address - Zip Code:02562-2622
Mailing Address - Country:US
Mailing Address - Phone:508-888-0530
Mailing Address - Fax:774-413-9379
Practice Address - Street 1:33 SAGAMORE RD
Practice Address - Street 2:
Practice Address - City:SAGAMORE BEACH
Practice Address - State:MA
Practice Address - Zip Code:02562-2622
Practice Address - Country:US
Practice Address - Phone:774-413-9379
Practice Address - Fax:774-413-9379
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2008-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1186225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist