Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 02759 | MD |
NPI | 1922149814 |
---|---|
Provider Name | Annette Lynn Lavezza |
First Address | Glen Arm, MD 21057-9252 |
Second Address | Lutherville, MD 21093-4535 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 08/07/2007 |