Provider Demographics
NPI:1689008278
Name:PUDEL, ANNA (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:PUDEL
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 1:76 LOTT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-4811
Mailing Address - Country:US
Mailing Address - Phone:718-495-7759
Mailing Address - Fax:718-345-8255
Practice Address - Street 1:76 LOTT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-4811
Practice Address - Country:US
Practice Address - Phone:718-495-7759
Practice Address - Fax:718-345-8255
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0182381225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist