Healthcare Provider Details

I. General information

NPI: 1053644484
Provider Name (Legal Business Name): ANNA MARIE KALASHNIK OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 09/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 LEXINGTON AVE
MANSFIELD OH
44907-1502
US

IV. Provider business mailing address

535 LEXINGTON AVE
MANSFIELD OH
44907-1502
US

V. Phone/Fax

Practice location:
  • Phone: 419-756-7111
  • Fax:
Mailing address:
  • Phone: 419-756-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 003121
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: