Provider Demographics
NPI:1003990508
Name:WITT, ANITA DENISE (MAE, PLE, DI)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:DENISE
Last Name:WITT
Suffix:
Gender:F
Credentials:MAE, PLE, DI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 WINGATE AVE
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-2257
Mailing Address - Country:US
Mailing Address - Phone:270-361-2718
Mailing Address - Fax:270-361-2718
Practice Address - Street 1:117 WINGATE AVE
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-2257
Practice Address - Country:US
Practice Address - Phone:270-361-2718
Practice Address - Fax:270-361-2718
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY174400000X, 222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No174400000XOther Service ProvidersSpecialist