Provider Demographics
NPI:1982746681
Name:LOZANOVSKI, CASSIE LYNN (OTR)
Entity type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:LYNN
Last Name:LOZANOVSKI
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 1:22706 W SIERRA RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:WITTMANN
Mailing Address - State:AZ
Mailing Address - Zip Code:85361-8788
Mailing Address - Country:US
Mailing Address - Phone:623-388-0910
Mailing Address - Fax:
Practice Address - Street 1:22706 W SIERRA RIDGE WAY
Practice Address - Street 2:
Practice Address - City:WITTMANN
Practice Address - State:AZ
Practice Address - Zip Code:85361-8788
Practice Address - Country:US
Practice Address - Phone:623-388-0910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2609225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ530586Medicare UPIN