Provider Demographics
NPI:1639706906
Name:ROSS, ANITA (DROT, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:DROT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LEATHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3903
Mailing Address - Country:US
Mailing Address - Phone:610-945-5837
Mailing Address - Fax:
Practice Address - Street 1:11 LEATHERWOOD DR
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3903
Practice Address - Country:US
Practice Address - Phone:610-945-5837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA190918529225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist