Provider Demographics
NPI:1912916164
Name:WARDSWORTH, ANNA G (OTR)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:G
Last Name:WARDSWORTH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 19TH ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-6753
Mailing Address - Country:US
Mailing Address - Phone:318-473-2917
Mailing Address - Fax:318-473-4002
Practice Address - Street 1:409 19TH ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-6753
Practice Address - Country:US
Practice Address - Phone:318-473-2917
Practice Address - Fax:318-473-4002
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ10937225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAZ10937OtherSTATE LICENSE NUMBER
LA5H269Medicare ID - Type UnspecifiedOCCUPATIONAL THERAPY