Provider Demographics
NPI:1578765343
Name:DEOLE, ANAGHA ASHOK (OTR L)
Entity Type:Individual
Prefix:MRS
First Name:ANAGHA
Middle Name:ASHOK
Last Name:DEOLE
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 1:1008 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-6437
Mailing Address - Country:US
Mailing Address - Phone:620-231-3316
Mailing Address - Fax:
Practice Address - Street 1:1102 E CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-6643
Practice Address - Country:US
Practice Address - Phone:620-232-0229
Practice Address - Fax:620-235-7817
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-00823225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist