Provider Demographics
NPI:1952636235
Name:BITZ, LYNN VIRGILLIO
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:VIRGILLIO
Last Name:BITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:MARIE
Other - Last Name:VIRGILLIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:5824 GLEN EAGLES COURT
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123
Mailing Address - Country:US
Mailing Address - Phone:317-919-8846
Mailing Address - Fax:
Practice Address - Street 1:5834 GLEN EAGLES CT
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8114
Practice Address - Country:US
Practice Address - Phone:317-718-0210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004279A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
31004279AOtherINDIANA PROFESSIONAL LICENSING AGENCY