Provider Demographics
NPI:1881024446
Name:WHALE, ANNA MARIE
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MARIE
Last Name:WHALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7008 MAPLELAWN DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1764
Mailing Address - Country:US
Mailing Address - Phone:734-484-0362
Mailing Address - Fax:
Practice Address - Street 1:22950 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4696
Practice Address - Country:US
Practice Address - Phone:734-287-1230
Practice Address - Fax:734-287-1906
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007185225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5201007185OtherOCCUPATIONAL THERAPIST LICENSE