Provider Demographics
NPI:1285907642
Name:LANZENDORFER, BRIANNE LYN (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:BRIANNE
Middle Name:LYN
Last Name:LANZENDORFER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3891 LOWER ELKTON RD
Mailing Address - Street 2:
Mailing Address - City:LEETONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44431-9631
Mailing Address - Country:US
Mailing Address - Phone:330-692-0135
Mailing Address - Fax:
Practice Address - Street 1:8064 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6153
Practice Address - Country:US
Practice Address - Phone:330-726-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03437224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant