Provider Demographics
NPI:1588793905
Name:WINSTON, LENA (OTR)
Entity type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:WINSTON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 DONEGAL CIR
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-2316
Mailing Address - Country:US
Mailing Address - Phone:978-762-0318
Mailing Address - Fax:978-762-3833
Practice Address - Street 1:12 DONEGAL CIR
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2316
Practice Address - Country:US
Practice Address - Phone:978-762-0318
Practice Address - Fax:978-762-3833
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6225225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0703575Medicaid