Provider Demographics
NPI:1063433407
Name:LENTZ, ROBERT MICHEAL JR (OTR L)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHEAL
Last Name:LENTZ
Suffix:JR
Gender:M
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 DENTS RUN RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-2005
Mailing Address - Country:US
Mailing Address - Phone:304-225-7529
Mailing Address - Fax:304-985-7529
Practice Address - Street 1:483 DENTS RUN RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-2005
Practice Address - Country:US
Practice Address - Phone:304-225-7529
Practice Address - Fax:304-985-7529
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV896225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist