Provider Demographics
NPI:1275927246
Name:SOLED, ANYA ROSE (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:ANYA
Middle Name:ROSE
Last Name:SOLED
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 1:5554 THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-9377
Mailing Address - Country:US
Mailing Address - Phone:415-250-9288
Mailing Address - Fax:
Practice Address - Street 1:5554 THOMAS RD
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-9377
Practice Address - Country:US
Practice Address - Phone:415-297-8892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT19521225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics