Basic Information
| Provider Information | |||||||||
| NPI: | 1447587738 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANCAJAS | ||||||||
| FirstName: | MAUREEN | ||||||||
| MiddleName: | SORSONI | ||||||||
| NamePrefix: | |||||||||
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| Credential: | OTR | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TAGSIP | ||||||||
| OtherFirstName: | MAUREEN | ||||||||
| OtherMiddleName: | ANCAJAS | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1920 OLD SPRINGVILLE RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | CENTER POINT | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352155858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7324039448 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3325 STATE ROUTE 35 | ||||||||
| Address2: | |||||||||
| City: | HAZLET | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077301552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322645800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2009 | ||||||||
| LastUpdateDate: | 09/10/2011 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 2608 | NM | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 113326 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 2009029855 | MO | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 46TR00519200 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.