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General NPI Number Information
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NPI Number | 1972968287
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Entity Type | Individual
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Provider Name | ANOUSONE INTHIRATH
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Gender | Female
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Dates
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Enumeration Date | 12/31/2015
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Last Update Date | 06/08/2025
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Provider Practice Location Address
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Address Line | 670 S DAHLIA CIR APT R-306
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City | DENVER
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State | CO
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Zip | 80246-3303
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Country | US
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Telephone | 904-207-2991
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Fax |
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Provider Business Mailing Address
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Address Line | 718 EDGEWOOD PL UNIT 103
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City | WHITEFISH
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State | MT
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Zip | 59937-3479
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Country | US
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Telephone | 904-207-2991
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTP-OTA-LIC-10547
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License Number State | MT
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