Provider Demographics
NPI:1912039751
Name:LINDBERG, ANN MARIE (OTR)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:MARIE
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 BAYLEAF LN
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-1225
Mailing Address - Country:US
Mailing Address - Phone:336-545-0258
Mailing Address - Fax:336-545-3321
Practice Address - Street 1:5710 BAYLEAF LN
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-1225
Practice Address - Country:US
Practice Address - Phone:336-545-0258
Practice Address - Fax:336-545-3321
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1628225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301072Medicaid