Healthcare Provider Details

I. General information

NPI: 1871047514
Provider Name (Legal Business Name): ANNA K WOLD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282D CEDARBRIDGE AVE
LAKEWOOD NJ
08701-4265
US

IV. Provider business mailing address

604 CUMBERLAND AVE
TEANECK NJ
07666-1814
US

V. Phone/Fax

Practice location:
  • Phone: 732-987-5122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: