Provider Demographics
NPI:1699344515
Name:WAN, ANNA (MSOT, OTR/L, CSRS)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:WAN
Suffix:
Gender:F
Credentials:MSOT, OTR/L, CSRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W CLARENDON AVE STE 285
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3474
Mailing Address - Country:US
Mailing Address - Phone:602-279-6905
Mailing Address - Fax:
Practice Address - Street 1:2195 W CHANDLER BLVD STE 180
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6580
Practice Address - Country:US
Practice Address - Phone:480-963-9339
Practice Address - Fax:480-963-4098
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6678225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist