Provider Demographics
NPI:1730515248
Name:TYNER, ANNA WESTON (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:WESTON
Last Name:TYNER
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 1:2046 SHADOW FERRY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-6648
Mailing Address - Country:US
Mailing Address - Phone:843-206-2908
Mailing Address - Fax:
Practice Address - Street 1:2046 SHADOW FERRY DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-6648
Practice Address - Country:US
Practice Address - Phone:843-206-2908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4174225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist