Provider Demographics
NPI:1851065031
Name:PABALAN, ANNIE ACUNA
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:ACUNA
Last Name:PABALAN
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 1:19246 SHARON DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2472
Mailing Address - Country:US
Mailing Address - Phone:240-383-8678
Mailing Address - Fax:
Practice Address - Street 1:19246 SHARON DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2472
Practice Address - Country:US
Practice Address - Phone:240-383-8678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA02905224Z00000X
PAOP009942224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant