Provider Demographics
NPI:1902442296
Name:HITES, ANNIKA DOROTHY (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ANNIKA
Middle Name:DOROTHY
Last Name:HITES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:ANNIKA
Other - Middle Name:DOROTHY
Other - Last Name:SWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12347 165TH ST
Mailing Address - Street 2:
Mailing Address - City:MILACA
Mailing Address - State:MN
Mailing Address - Zip Code:56353-3301
Mailing Address - Country:US
Mailing Address - Phone:612-532-0229
Mailing Address - Fax:
Practice Address - Street 1:1994 E RUM RIVER DR S
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-2663
Practice Address - Country:US
Practice Address - Phone:763-689-5385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103658225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist