Provider Demographics
NPI:1972960839
Name:GARDNER, ANNA LAUREN (OTR/L)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:LAUREN
Last Name:GARDNER
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 1:544 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4806
Mailing Address - Country:US
Mailing Address - Phone:856-589-4224
Mailing Address - Fax:856-810-5788
Practice Address - Street 1:544 LIPPINCOTT DR
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-589-4224
Practice Address - Fax:856-810-5788
Is Sole Proprietor?:No
Enumeration Date:2016-01-24
Last Update Date:2018-05-16
Deactivation Date:2018-04-30
Deactivation Code:
Reactivation Date:2018-05-16
Provider Licenses
StateLicense IDTaxonomies
PAOC014221225X00000X
NJ46TR00752600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist