Provider Demographics
NPI:1235973777
Name:ADDLESBERGER, ANITA RUTA
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:RUTA
Last Name:ADDLESBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19087 KING PL
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-9599
Mailing Address - Country:US
Mailing Address - Phone:219-776-5352
Mailing Address - Fax:
Practice Address - Street 1:221 US HIGHWAY 41 STE H
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1278
Practice Address - Country:US
Practice Address - Phone:219-322-1600
Practice Address - Fax:219-322-9786
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000492A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist