Provider Demographics
NPI:1669770418
Name:GOINS, ANNA MARIE (OTR-L)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:GOINS
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:MARIE
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:613 DORBETT STREET
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-2615
Mailing Address - Country:US
Mailing Address - Phone:812-482-9536
Mailing Address - Fax:812-634-9719
Practice Address - Street 1:1458 WEST DIVISION ROAD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-9777
Practice Address - Country:US
Practice Address - Phone:812-482-9536
Practice Address - Fax:812-634-9719
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31005105A225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics