Provider Demographics
NPI:1164802203
Name:MCTISH, ANNA COLE (OTD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:COLE
Last Name:MCTISH
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:JEANNE
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:280 N MAIN ST
Mailing Address - Street 2:# 2
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6136
Mailing Address - Country:US
Mailing Address - Phone:801-292-8665
Mailing Address - Fax:
Practice Address - Street 1:280 N MAIN ST
Practice Address - Street 2:# 2
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6136
Practice Address - Country:US
Practice Address - Phone:801-292-8665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9421753-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist