Healthcare Provider Details

I. General information

NPI: 1346977014
Provider Name (Legal Business Name): ANNA PRENDERGAST OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 LINCOLN AVE STE 207
N CHARLEROI PA
15022-2451
US

IV. Provider business mailing address

625 LINCOLN AVE STE 209
N CHARLEROI PA
15022-2451
US

V. Phone/Fax

Practice location:
  • Phone: 724-483-4263
  • Fax: 724-483-3154
Mailing address:
  • Phone: 724-483-2159
  • Fax: 724-489-0282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOC018562
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: