Provider Demographics
NPI:1528317450
Name:FORD, ANNA KRISTINE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:KRISTINE
Last Name:FORD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 BATTLEGROUND DRIVE
Mailing Address - Street 2:
Mailing Address - City:IUKA
Mailing Address - State:MS
Mailing Address - Zip Code:38852-1311
Mailing Address - Country:US
Mailing Address - Phone:662-423-2103
Mailing Address - Fax:662-423-2988
Practice Address - Street 1:502 BATTLEGROUND DRIVE
Practice Address - Street 2:
Practice Address - City:IUKA
Practice Address - State:MS
Practice Address - Zip Code:38852-1311
Practice Address - Country:US
Practice Address - Phone:662-423-2103
Practice Address - Fax:662-423-2988
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT2341174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist