Provider Demographics
NPI:1083476121
Name:PACE, ANNAH BALEY (COTA/L)
Entity Type:Individual
Prefix:
First Name:ANNAH
Middle Name:BALEY
Last Name:PACE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 BISCAYNE
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-4201
Mailing Address - Country:US
Mailing Address - Phone:870-914-1013
Mailing Address - Fax:
Practice Address - Street 1:6700 HIGHWAY 165 N
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-8753
Practice Address - Country:US
Practice Address - Phone:318-362-4206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA340089224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant