Provider Demographics
NPI:1649788175
Name:KETABI, MARGARET ANNE (OT)
Entity type:Individual
Prefix:
First Name:MARGARET ANNE
Middle Name:
Last Name:KETABI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 APPLE TREE LN APT B
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-3055
Mailing Address - Country:US
Mailing Address - Phone:205-223-1437
Mailing Address - Fax:
Practice Address - Street 1:1937 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4510
Practice Address - Country:US
Practice Address - Phone:850-769-7686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-18
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
FLOT18958225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist