Provider Demographics
NPI:1811641723
Name:BAIONI, ANNA KATHRYN (COTA/L)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:KATHRYN
Last Name:BAIONI
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2144 LAKESHORE DR APT 7C
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1028
Mailing Address - Country:US
Mailing Address - Phone:662-588-2295
Mailing Address - Fax:
Practice Address - Street 1:5140 GALAXIE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4335
Practice Address - Country:US
Practice Address - Phone:662-714-3122
Practice Address - Fax:888-228-1594
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSTA3710224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant