Provider Demographics
NPI:1780235218
Name:ANYANE-YEBOA, MAVIS NTOAH (COTA)
Entity type:Individual
Prefix:
First Name:MAVIS
Middle Name:NTOAH
Last Name:ANYANE-YEBOA
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 1:101 KENNEDY DR APT G1
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-5389
Mailing Address - Country:US
Mailing Address - Phone:845-729-5963
Mailing Address - Fax:
Practice Address - Street 1:101 KENNEDY DR APT G1
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-5389
Practice Address - Country:US
Practice Address - Phone:845-729-5963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant