Provider Demographics
NPI:1477198919
Name:KALESSE, ANA R
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:R
Last Name:KALESSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 SEDGEWICK DR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:DE
Mailing Address - Zip Code:19962-3212
Mailing Address - Country:US
Mailing Address - Phone:518-526-4131
Mailing Address - Fax:
Practice Address - Street 1:490 SEDGEWICK DR
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:DE
Practice Address - Zip Code:19962-3212
Practice Address - Country:US
Practice Address - Phone:518-526-4131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU1-0012224225X00000X
NJ46TR00771200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist