Provider Demographics
NPI:1992052096
Name:LYNNE J. GANZ, OTR/L, INC.
Entity type:Organization
Organization Name:LYNNE J. GANZ, OTR/L, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GANZ
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:703-796-9887
Mailing Address - Street 1:11708 BOWMAN GREEN DR
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3501
Mailing Address - Country:US
Mailing Address - Phone:703-796-9887
Mailing Address - Fax:
Practice Address - Street 1:11708 BOWMAN GREEN DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3501
Practice Address - Country:US
Practice Address - Phone:703-796-9887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000014225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty