Provider Demographics
NPI:1497023261
Name:NIKITSCHER, ANNA (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:
Last Name:NIKITSCHER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MRS
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:HIDALGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA/L
Mailing Address - Street 1:515 PUEBLO DR
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-5621
Mailing Address - Country:US
Mailing Address - Phone:708-220-5872
Mailing Address - Fax:
Practice Address - Street 1:515 PUEBLO DR
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-5621
Practice Address - Country:US
Practice Address - Phone:708-220-5872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057002806224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant