Provider Demographics
NPI:1043072424
Name:WHITACRE, ANNA (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:WHITACRE
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:CARNEVALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:261 TRIFECTA CT APT 64
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:KY
Mailing Address - Zip Code:41094-7210
Mailing Address - Country:US
Mailing Address - Phone:513-324-4694
Mailing Address - Fax:
Practice Address - Street 1:4710 TIMBER TRAIL DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-5399
Practice Address - Country:US
Practice Address - Phone:513-423-9496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT012761225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist