Provider Demographics
NPI:1124274741
Name:EXLINE, ANNA ELIZABETH (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:ELIZABETH
Last Name:EXLINE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:ROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3033 E THUNDERBIRD RD
Mailing Address - Street 2:APT 2042
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-5681
Mailing Address - Country:US
Mailing Address - Phone:608-338-9295
Mailing Address - Fax:
Practice Address - Street 1:3033 E THUNDERBIRD RD
Practice Address - Street 2:APT 2042
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5681
Practice Address - Country:US
Practice Address - Phone:608-338-9295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4138225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics