Healthcare Provider Details

I. General information

NPI: 1629694948
Provider Name (Legal Business Name): ANAYA L TRAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 07/16/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 HENDERSON RD
COLUMBUS OH
43220-4004
US

IV. Provider business mailing address

4214 BOWMAN MEADOW DR
CANAL WINCHESTER OH
43110-7843
US

V. Phone/Fax

Practice location:
  • Phone: 614-809-3581
  • Fax:
Mailing address:
  • Phone: 614-267-7003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: