Provider Demographics
NPI:1316317894
Name:MEAD, ANTHONY (OTR)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:MEAD
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 H ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2061
Mailing Address - Country:US
Mailing Address - Phone:814-853-5621
Mailing Address - Fax:
Practice Address - Street 1:890 H ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2061
Practice Address - Country:US
Practice Address - Phone:814-853-5621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC014103225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
346886OtherNATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY