Provider Demographics
NPI:1417345737
Name:MATHEW, ANNE
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 W ORANGE AVE
Mailing Address - Street 2:APT # 9
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3277
Mailing Address - Country:US
Mailing Address - Phone:714-406-6131
Mailing Address - Fax:
Practice Address - Street 1:2960 W ORANGE AVE
Practice Address - Street 2:APT # 9
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3277
Practice Address - Country:US
Practice Address - Phone:714-406-6131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14133225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist