Basic Information
| Provider Information | |||||||||
| NPI: | 1922149814 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAVEZZA | ||||||||
| FirstName: | ANNETTE | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11903 LONG GREEN PIKE | ||||||||
| Address2: | |||||||||
| City: | GLEN ARM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210579252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106143234 | ||||||||
| FaxNumber: | 4106142065 | ||||||||
| Practice Location | |||||||||
| Address1: | 10753 FALLS RD | ||||||||
| Address2: | SUITE 235 | ||||||||
| City: | LUTHERVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210934535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105832665 | ||||||||
| FaxNumber: | 4108473838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XN1300X | 02759 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Neurorehabilitation |
No ID Information.