Provider Demographics
NPI:1972727634
Name:CENTAFONT, LUCY ANN (OTRL)
Entity type:Individual
Prefix:MS
First Name:LUCY
Middle Name:ANN
Last Name:CENTAFONT
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MS
Other - First Name:LUCY
Other - Middle Name:ANN
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:1345 CURTIS RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3339
Mailing Address - Country:US
Mailing Address - Phone:215-322-8374
Mailing Address - Fax:
Practice Address - Street 1:1345 CURTIS RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3339
Practice Address - Country:US
Practice Address - Phone:215-322-8374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC000089L225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019643150003OtherMA PROMISE
PA0019643150004OtherMA PROMISE