Provider Demographics
NPI:1790942530
Name:FORD-LANZA, ALESCIA C (MS, OTR/L, ATP)
Entity Type:Individual
Prefix:
First Name:ALESCIA
Middle Name:C
Last Name:FORD-LANZA
Suffix:
Gender:F
Credentials:MS, OTR/L, ATP
Other - Prefix:
Other - First Name:ALESCIA
Other - Middle Name:C
Other - Last Name:BALDWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PO BOX 231
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001
Mailing Address - Country:US
Mailing Address - Phone:860-470-3391
Mailing Address - Fax:203-775-0238
Practice Address - Street 1:37 OAK RIDGE DR
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-2213
Practice Address - Country:US
Practice Address - Phone:860-470-3391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0029052251P0200X, 225X00000X
CT86644231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner