Provider Demographics
NPI:1942525191
Name:LEWIS, MARY ANNE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANNE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:ANNE
Other - Last Name:GEIGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:717 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:STOWE
Mailing Address - State:VT
Mailing Address - Zip Code:05672-4250
Mailing Address - Country:US
Mailing Address - Phone:802-477-3928
Mailing Address - Fax:802-253-9384
Practice Address - Street 1:717 MAPLE ST
Practice Address - Street 2:
Practice Address - City:STOWE
Practice Address - State:VT
Practice Address - Zip Code:05672-4250
Practice Address - Country:US
Practice Address - Phone:802-477-3928
Practice Address - Fax:802-253-9384
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072.0062201225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist