Provider Demographics
NPI:1891100608
Name:LANZA, ROSEMARY CORRINE (MSA, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ROSEMARY
Middle Name:CORRINE
Last Name:LANZA
Suffix:
Gender:F
Credentials:MSA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6718 CYPRESS MIST DR
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-3424
Mailing Address - Country:US
Mailing Address - Phone:210-490-2419
Mailing Address - Fax:
Practice Address - Street 1:6718 CYPRESS MIST DR
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-3424
Practice Address - Country:US
Practice Address - Phone:210-490-2419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107738174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist