Provider Demographics
NPI:1447971437
Name:HUBER, ANNA (OTD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:HUBER
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15630 PINEHURST DR STE 1
Mailing Address - Street 2:
Mailing Address - City:BASEHOR
Mailing Address - State:KS
Mailing Address - Zip Code:66007-8238
Mailing Address - Country:US
Mailing Address - Phone:191-372-8206
Mailing Address - Fax:
Practice Address - Street 1:15630 PINEHURST DR STE 1
Practice Address - Street 2:
Practice Address - City:BASEHOR
Practice Address - State:KS
Practice Address - Zip Code:66007-8238
Practice Address - Country:US
Practice Address - Phone:913-728-2065
Practice Address - Fax:913-273-2423
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-04033225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
475189OtherNBCOT #