Provider Demographics
NPI:1013571330
Name:COREY, ANNA MARIE (COTA)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:COREY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:MARIE
Other - Last Name:HOLTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24212 SUMNER BUCKLEY HWY E
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321-9413
Mailing Address - Country:US
Mailing Address - Phone:253-651-2342
Mailing Address - Fax:
Practice Address - Street 1:24212 SUMNER BUCKLEY HWY E
Practice Address - Street 2:
Practice Address - City:BUCKLEY
Practice Address - State:WA
Practice Address - Zip Code:98321-9413
Practice Address - Country:US
Practice Address - Phone:253-651-2342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60928738224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant