Provider Demographics
NPI:1326246760
Name:THANASACK, LEE ANN (OTR)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ANN
Last Name:THANASACK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3556 NATALIE DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-9461
Mailing Address - Country:US
Mailing Address - Phone:614-327-9616
Mailing Address - Fax:
Practice Address - Street 1:5471 SCIOTO DARBY RD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1310
Practice Address - Country:US
Practice Address - Phone:614-876-7356
Practice Address - Fax:614-529-7121
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT 005698225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist