Provider Demographics
NPI:1508399908
Name:PERLMUTTER, ANNA (OT)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:
Last Name:PERLMUTTER
Suffix:
Gender:F
Credentials:OT
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Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 FOREST PARK AVE
Mailing Address - Street 2:MSC 8505-66-01
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2212
Mailing Address - Country:US
Mailing Address - Phone:314-286-1669
Mailing Address - Fax:314-283-6131
Practice Address - Street 1:4444 FOREST PARK AVE
Practice Address - Street 2:DEPT OCCUPATIONAL THERAPY, STE 2210
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2212
Practice Address - Country:US
Practice Address - Phone:314-286-1669
Practice Address - Fax:314-289-6131
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2021032071225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO470101787Medicaid