Provider Demographics
NPI:1962636449
Name:IRA, ANNA TISHA ABAD (OTR)
Entity Type:Individual
Prefix:
First Name:ANNA TISHA
Middle Name:ABAD
Last Name:IRA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6033 S SAN JACINTO ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-4231
Mailing Address - Country:US
Mailing Address - Phone:480-656-7295
Mailing Address - Fax:
Practice Address - Street 1:6458 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1727
Practice Address - Country:US
Practice Address - Phone:480-832-5160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4283225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist