Provider Demographics
NPI:1114967650
Name:NESLAND, ANITA LORAINE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:LORAINE
Last Name:NESLAND
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:PO BOX 344
Mailing Address - Street 2:205 2ND ST.
Mailing Address - City:JUNIOR
Mailing Address - State:WV
Mailing Address - Zip Code:26275-0344
Mailing Address - Country:US
Mailing Address - Phone:304-823-1505
Mailing Address - Fax:304-823-1505
Practice Address - Street 1:205 2ND ST.
Practice Address - Street 2:
Practice Address - City:JUNIOR
Practice Address - State:WV
Practice Address - Zip Code:26275-0344
Practice Address - Country:US
Practice Address - Phone:304-823-1505
Practice Address - Fax:304-823-1505
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV430225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7503054-000Medicaid
WV7503054-000Medicaid
WVNE4068561Medicare ID - Type UnspecifiedMEDICARE #