Provider Demographics
NPI:1194459156
Name:MOTON, ANAIS (LAT, ATC, MBL)
Entity type:Individual
Prefix:
First Name:ANAIS
Middle Name:
Last Name:MOTON
Suffix:
Gender:F
Credentials:LAT, ATC, MBL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-4714
Mailing Address - Country:US
Mailing Address - Phone:224-656-4097
Mailing Address - Fax:
Practice Address - Street 1:30 CAMPUS RD
Practice Address - Street 2:
Practice Address - City:ANNANDALE ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12504-9800
Practice Address - Country:US
Practice Address - Phone:845-758-7694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0036092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer