=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558874750
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNA STRUEMPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2017
-----------------------------------------------------
Last Update Date | 11/09/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 811 SOUTHWOOD BLVD UNIT 19
-----------------------------------------------------
City | INCLINE VILLAGE
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89451-7504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-694-8722
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5442
-----------------------------------------------------
City | INCLINE VILLAGE
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89450-5442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
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 | 16-0792
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------