=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508350281
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNE MARGARET VAN HUBEN OT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2018
-----------------------------------------------------
Last Update Date | 06/18/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | ELDERWOOD AT NORTH CREEK 112 SKI BOWL ROAD
-----------------------------------------------------
City | NORTH CREEK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-251-4722
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8106 REGENCY PARK APTS N
-----------------------------------------------------
City | QUEENSBURY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12804-1438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-242-1375
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 022284
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------