Provider Demographics
NPI:1235484783
Name:ANAYA PANTOJA, MARIA M (OT)
Entity Type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:M
Last Name:ANAYA PANTOJA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503-1632
Mailing Address - Country:US
Mailing Address - Phone:973-405-8222
Mailing Address - Fax:
Practice Address - Street 1:536 RIDGE RD
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1611
Practice Address - Country:US
Practice Address - Phone:973-405-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00572000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist