Provider Demographics
NPI:1154977122
Name:THIRY-DREDGE, ANAIS JEANNE MARIE FLORENCE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ANAIS JEANNE
Middle Name:MARIE FLORENCE
Last Name:THIRY-DREDGE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:ANAIS
Other - Middle Name:A
Other - Last Name:MOUILLESEAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8521 SHEFFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775-1826
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:273 E BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3775
Practice Address - Country:US
Practice Address - Phone:323-724-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18305225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist