Provider Demographics
NPI:1891171633
Name:BREITWIESER, ANNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:BREITWIESER
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 1:1215 NAVAJO TRAIL WEST DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-3560
Mailing Address - Country:US
Mailing Address - Phone:816-679-8046
Mailing Address - Fax:
Practice Address - Street 1:1215 NAVAJO TRAIL WEST DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-3560
Practice Address - Country:US
Practice Address - Phone:816-679-8046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9896225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist