Provider Demographics
NPI:1265315378
Name:PETRUSCHKA, ANAT
Entity type:Individual
Prefix:
First Name:ANAT
Middle Name:
Last Name:PETRUSCHKA
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 1:45 HAYWARD ST APT 1338
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02142-1707
Mailing Address - Country:US
Mailing Address - Phone:617-899-3690
Mailing Address - Fax:
Practice Address - Street 1:45 HAYWARD ST APT 1338
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02142-1707
Practice Address - Country:US
Practice Address - Phone:617-899-3690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAOTL36120225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist