Provider Demographics
NPI:1922149814
Name:LAVEZZA, ANNETTE LYNN (OTR)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:LYNN
Last Name:LAVEZZA
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 1:11903 LONG GREEN PIKE
Mailing Address - Street 2:
Mailing Address - City:GLEN ARM
Mailing Address - State:MD
Mailing Address - Zip Code:21057-9252
Mailing Address - Country:US
Mailing Address - Phone:410-614-3234
Mailing Address - Fax:410-614-2065
Practice Address - Street 1:10753 FALLS RD
Practice Address - Street 2:SUITE 235
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4535
Practice Address - Country:US
Practice Address - Phone:410-583-2665
Practice Address - Fax:410-847-3838
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02759225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation