Provider Demographics
NPI:1871717546
Name:PRAULT, ANNE (COTA)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:PRAULT
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 1:4755 SABAL KEY DR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-3129
Mailing Address - Country:US
Mailing Address - Phone:941-752-0408
Mailing Address - Fax:941-870-0876
Practice Address - Street 1:4440B 26TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-1201
Practice Address - Country:US
Practice Address - Phone:941-752-0408
Practice Address - Fax:941-870-0876
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA10349224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8901333Medicaid