Provider Demographics
NPI:1750389904
Name:LUTZ, MARY K (OT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:K
Last Name:LUTZ
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:KRIS
Other - Last Name:LUTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:4701 CREEK RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-8398
Mailing Address - Country:US
Mailing Address - Phone:513-733-9333
Mailing Address - Fax:513-588-2479
Practice Address - Street 1:6909 GOOD SAMARITAN DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-5207
Practice Address - Country:US
Practice Address - Phone:513-245-5434
Practice Address - Fax:513-245-5424
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT 02038225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000328340OtherANTHEM
OH2507086Medicaid
OHH189890Medicare PIN
OHLU4139721Medicare PIN
OH000000328340OtherANTHEM
OH2507086Medicaid