Provider Demographics
NPI:1104227594
Name:HENDERSON, ANNA BLAIR
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:BLAIR
Last Name:HENDERSON
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 1:1351 FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4456
Mailing Address - Country:US
Mailing Address - Phone:704-534-4471
Mailing Address - Fax:
Practice Address - Street 1:1351 FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4456
Practice Address - Country:US
Practice Address - Phone:704-534-4471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2024-01-30
Deactivation Date:2016-04-06
Deactivation Code:
Reactivation Date:2024-01-30
Provider Licenses
StateLicense IDTaxonomies
SC225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist