Provider Demographics
NPI:1497952741
Name:TAKAMI, ANN CHRISTINE (COTA)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:CHRISTINE
Last Name:TAKAMI
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3403 LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-9728
Mailing Address - Country:US
Mailing Address - Phone:812-987-6561
Mailing Address - Fax:
Practice Address - Street 1:900 ANSON ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-1982
Practice Address - Country:US
Practice Address - Phone:812-883-4681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001211A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant