Provider Demographics
NPI:1992077374
Name:PORDAN, ANNE MARIE ELIZABETH (COTA)
Entity type:Individual
Prefix:MRS
First Name:ANNE MARIE
Middle Name:ELIZABETH
Last Name:PORDAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 CHARLESGATE CIR
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1277
Mailing Address - Country:US
Mailing Address - Phone:716-689-8582
Mailing Address - Fax:
Practice Address - Street 1:252 CHARLESGATE CIR
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1277
Practice Address - Country:US
Practice Address - Phone:716-689-8582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004440-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant