Provider Demographics
NPI:1831313519
Name:DALLMAN, ANITA RACHAEL (COTA)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:RACHAEL
Last Name:DALLMAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:RACHAEL
Other - Last Name:BEAMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:1046 S TRACY ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-1588
Mailing Address - Country:US
Mailing Address - Phone:559-802-3024
Mailing Address - Fax:
Practice Address - Street 1:1046 S TRACY ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-1588
Practice Address - Country:US
Practice Address - Phone:559-802-3024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005009934224Z00000X
CA1945224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant