Provider Demographics
NPI:1548400666
Name:ESHELMAN, ANNETTE T (COTA)
Entity Type:Individual
Prefix:MISS
First Name:ANNETTE
Middle Name:T
Last Name:ESHELMAN
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 1:3232 W ROYAL LN
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3105
Mailing Address - Country:US
Mailing Address - Phone:866-756-0002
Mailing Address - Fax:
Practice Address - Street 1:255 LEBANON AVE
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-7828
Practice Address - Country:US
Practice Address - Phone:972-830-4473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2019-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant