Provider Demographics
NPI:1558591453
Name:MATHIS, ANITA MARIE (MS, SPECIAL ED)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:MARIE
Last Name:MATHIS
Suffix:
Gender:F
Credentials:MS, SPECIAL ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 LANDINGS LOOP
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-1289
Mailing Address - Country:US
Mailing Address - Phone:850-901-8697
Mailing Address - Fax:
Practice Address - Street 1:1202 LANDINGS LOOP
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-1289
Practice Address - Country:US
Practice Address - Phone:850-228-0844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010834900Medicaid