Provider Demographics
NPI:1437157468
Name:KANOZA, LORRIE C (OT)
Entity Type:Individual
Prefix:MRS
First Name:LORRIE
Middle Name:C
Last Name:KANOZA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:LORRIE
Other - Middle Name:C
Other - Last Name:SALTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:560 S LOOP RD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3405
Mailing Address - Country:US
Mailing Address - Phone:859-301-5540
Mailing Address - Fax:
Practice Address - Street 1:560 S LOOP RD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3405
Practice Address - Country:US
Practice Address - Phone:859-301-5540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR5087225XH1200X
OHOT 01591225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2507095Medicaid
OH000000344794OtherANTHEM
OHP00325332OtherMEDICARE RAILROAD
OH000000344794OtherANTHEM
OHP00325332OtherMEDICARE RAILROAD
Q26402Medicare UPIN