Provider Demographics
NPI:1700548682
Name:MCCLENDON, ANIKA (COTA)
Entity Type:Individual
Prefix:
First Name:ANIKA
Middle Name:
Last Name:MCCLENDON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 CAPITAL MEDICAL BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4446
Mailing Address - Country:US
Mailing Address - Phone:850-210-1172
Mailing Address - Fax:850-210-0047
Practice Address - Street 1:2711 CAPITAL MEDICAL BLVD STE E
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4446
Practice Address - Country:US
Practice Address - Phone:850-210-1172
Practice Address - Fax:850-210-0047
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA13890224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant