Provider Demographics
NPI:1346975943
Name:GAMMON, ANNA (COTA/L)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:GAMMON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 BYHALIA RD
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-1003
Mailing Address - Country:US
Mailing Address - Phone:662-469-2906
Mailing Address - Fax:662-469-4222
Practice Address - Street 1:1481 BYHALIA RD
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-1003
Practice Address - Country:US
Practice Address - Phone:662-469-2906
Practice Address - Fax:662-469-4229
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3828224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant