Provider Demographics
NPI:1821561754
Name:ANNIBALE, MARY LYNN (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LYNN
Last Name:ANNIBALE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 LEATHERMAN RD
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9236
Mailing Address - Country:US
Mailing Address - Phone:330-336-2120
Mailing Address - Fax:
Practice Address - Street 1:237 LEATHERMAN RD
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9236
Practice Address - Country:US
Practice Address - Phone:330-336-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH009075225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist