Provider Demographics
NPI:1568782613
Name:RICE, ANITA MICHELLE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:MICHELLE
Last Name:RICE
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 1:2557 E. STATE ROAD 55
Mailing Address - Street 2:P.O BOX 33
Mailing Address - City:NEWTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47969
Mailing Address - Country:US
Mailing Address - Phone:765-295-2049
Mailing Address - Fax:
Practice Address - Street 1:WATERS OF WILLIAMSPORT, 200 SHORT ST.
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:IN
Practice Address - Zip Code:47993
Practice Address - Country:US
Practice Address - Phone:765-762-6887
Practice Address - Fax:765-762-6885
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001801A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant