Provider Demographics
NPI:1093420168
Name:KESHISHIAN, ANAHID (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ANAHID
Middle Name:
Last Name:KESHISHIAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 SHERIDAN PL
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:07022-1905
Mailing Address - Country:US
Mailing Address - Phone:201-400-7571
Mailing Address - Fax:
Practice Address - Street 1:409 SHERIDAN PL
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:NJ
Practice Address - Zip Code:07022-1905
Practice Address - Country:US
Practice Address - Phone:201-400-7571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01082100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist