Provider Demographics
NPI:1508671413
Name:GANTT, ANNA KATHERINE (COTA/L)
Entity type:Individual
Prefix:MISS
First Name:ANNA
Middle Name:KATHERINE
Last Name:GANTT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 W HUNTER CT
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-2773
Mailing Address - Country:US
Mailing Address - Phone:623-910-4732
Mailing Address - Fax:
Practice Address - Street 1:1951 W CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-3403
Practice Address - Country:US
Practice Address - Phone:602-601-2401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-08
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ050092224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant