Provider Demographics
NPI:1669545265
Name:ANAYA, LORETTA MARIE (OTRL)
Entity type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:MARIE
Last Name:ANAYA
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 E. MOODY ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105
Mailing Address - Country:US
Mailing Address - Phone:408-829-5441
Mailing Address - Fax:
Practice Address - Street 1:409 E MOODY AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-2428
Practice Address - Country:US
Practice Address - Phone:408-829-5441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 1297225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT 1297OtherSTATE LICENSE