Healthcare Provider Details

I. General information

NPI: 1326929563
Provider Name (Legal Business Name): ANNA QUAN OTR/L
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18408 N 46TH DR
GLENDALE AZ
85308-1512
US

IV. Provider business mailing address

18408 N 46TH DR
GLENDALE AZ
85308-1512
US

V. Phone/Fax

Practice location:
  • Phone: 757-416-4905
  • Fax:
Mailing address:
  • Phone: 757-416-4905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTH-010092
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: