Provider Demographics
NPI:1689613556
Name:LANSBERRY, LORI ANN (OT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:LANSBERRY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:BUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:3764 COLONEL DRAKE HWY
Mailing Address - Street 2:
Mailing Address - City:PATTON
Mailing Address - State:PA
Mailing Address - Zip Code:16668-5507
Mailing Address - Country:US
Mailing Address - Phone:814-674-2626
Mailing Address - Fax:
Practice Address - Street 1:615 W HIGH ST
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-1512
Practice Address - Country:US
Practice Address - Phone:814-472-5008
Practice Address - Fax:814-472-5014
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC004584L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist