Provider Demographics
NPI:1780294942
Name:MISHRA, ANAMIKA (OTR/L)
Entity type:Individual
Prefix:
First Name:ANAMIKA
Middle Name:
Last Name:MISHRA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9224 HARRINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8476
Mailing Address - Country:US
Mailing Address - Phone:334-235-0416
Mailing Address - Fax:
Practice Address - Street 1:400 12TH ST STE 25
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2415
Practice Address - Country:US
Practice Address - Phone:209-549-9875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5337225X00000X
CA21356225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist