Basic Information
Provider Information
NPI: 1538260153
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PAVLISIN
FirstName: ANNE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: OTR/L, CHT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: BARNES
OtherFirstName: ANNE
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: OTR/L, CHT
OtherLastNameType: 1
Mailing Information
Address1: 973 MICA DR
Address2: SUITE 201
City: CARSON CITY
State: NV
PostalCode: 897057255
CountryCode: US
TelephoneNumber: 7753923689
FaxNumber: 7757836191
Practice Location
Address1: 973 MICA DR
Address2: SUITE 201
City: CARSON CITY
State: NV
PostalCode: 897057255
CountryCode: US
TelephoneNumber: 7753923689
FaxNumber: 7757836191
Other Information
ProviderEnumerationDate: 09/26/2006
LastUpdateDate: 10/20/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225XH1200X0629NVY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand

No ID Information.


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