Provider Demographics
NPI:1891424305
Name:FAGOTTI, ANITA (OTR/L)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:FAGOTTI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 HUNTER DR
Mailing Address - Street 2:
Mailing Address - City:NEWFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08344-9528
Mailing Address - Country:US
Mailing Address - Phone:609-774-7273
Mailing Address - Fax:
Practice Address - Street 1:49 WALNUT ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-2117
Practice Address - Country:US
Practice Address - Phone:609-774-7273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01030900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist