Provider Demographics
NPI:1821799768
Name:NELLIKALA, ANNSU (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANNSU
Middle Name:
Last Name:NELLIKALA
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 1:2708 RIVERHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-3492
Mailing Address - Country:US
Mailing Address - Phone:267-456-0841
Mailing Address - Fax:
Practice Address - Street 1:2708 RIVERHOUSE RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-3492
Practice Address - Country:US
Practice Address - Phone:267-456-0841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC019072225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics