Provider Demographics
NPI:1568901965
Name:BECKETT-FEDARKO, ANNE MAIJA (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MAIJA
Last Name:BECKETT-FEDARKO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5606 RIDGE AVE
Mailing Address - Street 2:APT 2F
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2735
Mailing Address - Country:US
Mailing Address - Phone:410-227-5537
Mailing Address - Fax:
Practice Address - Street 1:5606 RIDGE AVE
Practice Address - Street 2:APT 2F
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-2735
Practice Address - Country:US
Practice Address - Phone:410-227-5537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC014682225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist