Provider Demographics
NPI:1235511007
Name:MORTENSEN, ANNA ELISABETH (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:ELISABETH
Last Name:MORTENSEN
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 1:3144 34TH ST APT 3R
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1742
Mailing Address - Country:US
Mailing Address - Phone:845-653-1909
Mailing Address - Fax:
Practice Address - Street 1:3144 34TH ST APT 3R
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-1742
Practice Address - Country:US
Practice Address - Phone:845-653-1909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017577-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist