Provider Demographics
NPI:1003493941
Name:CONGENI, LUCIA C
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:C
Last Name:CONGENI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 987
Mailing Address - Street 2:
Mailing Address - City:MIDDLEFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44062-0987
Mailing Address - Country:US
Mailing Address - Phone:440-993-1004
Mailing Address - Fax:440-574-7254
Practice Address - Street 1:14950 S SPRINGDALE AVE
Practice Address - Street 2:
Practice Address - City:MIDDLEFIELD
Practice Address - State:OH
Practice Address - Zip Code:44062-9661
Practice Address - Country:US
Practice Address - Phone:440-632-1007
Practice Address - Fax:440-574-7254
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT011378225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOT011378OtherSTATE BOARD LICENSE NUMBER