Provider Demographics
NPI:1669240081
Name:LENTCHAP, MIREILLE
Entity type:Individual
Prefix:
First Name:MIREILLE
Middle Name:
Last Name:LENTCHAP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18026 DONEGALL CT
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-8151
Mailing Address - Country:US
Mailing Address - Phone:240-386-7822
Mailing Address - Fax:
Practice Address - Street 1:18026 DONEGALL CT
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-8151
Practice Address - Country:US
Practice Address - Phone:240-386-7822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA02604224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant