Provider Demographics
NPI:1720380090
Name:KUTSON, ANASTASIA (OTR/L, MS)
Entity Type:Individual
Prefix:MS
First Name:ANASTASIA
Middle Name:
Last Name:KUTSON
Suffix:
Gender:F
Credentials:OTR/L, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10621 ANGLO HILL RD
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2934
Mailing Address - Country:US
Mailing Address - Phone:443-610-3107
Mailing Address - Fax:
Practice Address - Street 1:10621 ANGLO HILL RD
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-2934
Practice Address - Country:US
Practice Address - Phone:443-610-3107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014655-1225X00000X
MD05446225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist