Provider Demographics
NPI:1467688366
Name:OAKES, ANITA GWYNNE
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:GWYNNE
Last Name:OAKES
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 1:44 WESTSIDE RD
Mailing Address - Street 2:
Mailing Address - City:OWLS HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:12969-1701
Mailing Address - Country:US
Mailing Address - Phone:518-569-3118
Mailing Address - Fax:
Practice Address - Street 1:355 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1827
Practice Address - Country:US
Practice Address - Phone:518-569-3118
Practice Address - Fax:518-483-9378
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist