Basic Information
| Provider Information | |||||||||
| NPI: | 1003151911 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERS | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7985 FULTONROSE RD | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437779796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406972610 | ||||||||
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| Practice Location | |||||||||
| Address1: | 920 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NEW LEXINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437641552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403425161 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2012 | ||||||||
| LastUpdateDate: | 12/04/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 03624 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.