Healthcare Provider Details

I. General information

NPI: 1942534805
Provider Name (Legal Business Name): ANNEMARIE PETTY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 12/15/2019
Certification Date: 12/15/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W SPROUL RD # 125
SPRINGFIELD PA
19064-2033
US

IV. Provider business mailing address

103 STONEBROOK DR
LUMBERTON NJ
08048-4506
US

V. Phone/Fax

Practice location:
  • Phone: 610-544-0500
  • Fax:
Mailing address:
  • Phone: 609-220-9940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: