Basic Information
| Provider Information | |||||||||
| NPI: | 1790942530 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FORD-LANZA | ||||||||
| FirstName: | ALESCIA | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MS, OTR/L, ATP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BALDWIN | ||||||||
| OtherFirstName: | ALESCIA | ||||||||
| OtherMiddleName: | C | ||||||||
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| OtherCredential: | OTR/L | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 231 | ||||||||
| Address2: | |||||||||
| City: | AVON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604703391 | ||||||||
| FaxNumber: | 2037750238 | ||||||||
| Practice Location | |||||||||
| Address1: | 37 OAK RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | AVON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060012213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604703391 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2008 | ||||||||
| LastUpdateDate: | 07/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251P0200X | 002905 | CT | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | 231HA2400X | 86644 | CT | N | Speech, Language and Hearing Service Providers | Audiologist | Assistive Technology Practitioner | 225X00000X | 002905 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.