Provider Demographics
NPI:1417341553
Name:LAZICKI, KRISTINA MERRITT (ATC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MERRITT
Last Name:LAZICKI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HILLTOP CIR
Mailing Address - Street 2:RAC 221
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21250-0001
Mailing Address - Country:US
Mailing Address - Phone:410-455-3921
Mailing Address - Fax:410-455-1191
Practice Address - Street 1:1000 HILLTOP CIR
Practice Address - Street 2:RAC 221
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21250-0001
Practice Address - Country:US
Practice Address - Phone:410-455-3921
Practice Address - Fax:410-455-1191
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA006342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer