Provider Demographics
NPI:1891891297
Name:DAVID, ANITA MARIE (OT)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:MARIE
Last Name:DAVID
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:ANITA
Other - Middle Name:MARIE
Other - Last Name:DAVID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:1636 NW 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-5508
Mailing Address - Country:US
Mailing Address - Phone:954-865-3705
Mailing Address - Fax:954-204-0014
Practice Address - Street 1:1636 NW 5TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-5508
Practice Address - Country:US
Practice Address - Phone:954-865-3705
Practice Address - Fax:954-204-0014
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 11518225X00000X
FL11518222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891985200Medicaid
FL010042600Medicaid