Provider Demographics
NPI:1093279648
Name:PARYS-WOLODKEWITSCH, LANMANA
Entity Type:Individual
Prefix:
First Name:LANMANA
Middle Name:
Last Name:PARYS-WOLODKEWITSCH
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 1:411 W HAYCRAFT AVE STE D4
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8104
Mailing Address - Country:US
Mailing Address - Phone:208-664-2468
Mailing Address - Fax:
Practice Address - Street 1:411 W HAYCRAFT AVE STE D4
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8104
Practice Address - Country:US
Practice Address - Phone:208-664-2468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-2020225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics