Active NPI
Andrea Raphael, OT
- Occupational Therapist
- Fairport, NY
National Provider Identifier
1114412657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- P10746
- Practice address
- 4646 Fairport Nine Mile PT Rd
Fairport, NY 14450-1163 - Phone
- (585) 377-0350
- NPI assigned
- Jun 27, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | P10746 | NY | Primary |
Addresses
Primary practice location
4646 Fairport Nine Mile PT Rd
Fairport, NY 14450-1163
Mailing address
12 Chateau SQ
Rochester, NY 14618-5131
Phone (585) 813-5455
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P10746 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1530057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530057600000",
"number": "1114412657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 CHATEAU SQ",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146185131",
"telephone_number": "585-813-5455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4646 FAIRPORT NINE MILE PT RD",
"city": "FAIRPORT",
"state": "NY",
"postal_code": "144501163",
"telephone_number": "585-377-0350"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAPHAEL",
"first_name": "ANDREA",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-27",
"last_updated": "2018-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NY",
"license": "P10746",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.