Provider Demographics
NPI:1760704639
Name:WHITAKER, ANNPATRICE (OT)
Entity Type:Individual
Prefix:
First Name:ANNPATRICE
Middle Name:
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 REED RD
Mailing Address - Street 2:
Mailing Address - City:N SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-2235
Mailing Address - Country:US
Mailing Address - Phone:315-882-4370
Mailing Address - Fax:
Practice Address - Street 1:101 REED RD
Practice Address - Street 2:
Practice Address - City:N SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-2235
Practice Address - Country:US
Practice Address - Phone:315-882-4370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0047791--1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004779-1OtherLICENSE