Provider Demographics
NPI:1407108236
Name:PROCTOR, ANNE TEVES (OTR)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:TEVES
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:CONSTANCE
Other - Last Name:PROCTOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:20156 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95033-9509
Mailing Address - Country:US
Mailing Address - Phone:408-395-1687
Mailing Address - Fax:
Practice Address - Street 1:20156 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95033-9509
Practice Address - Country:US
Practice Address - Phone:408-395-1687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 3499225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist