Provider Demographics
NPI:1992162838
Name:LANUTO, KRYSTINA LEIGH (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:KRYSTINA
Middle Name:LEIGH
Last Name:LANUTO
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 LESTER AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-1825
Mailing Address - Country:US
Mailing Address - Phone:631-786-4417
Mailing Address - Fax:
Practice Address - Street 1:780 LESTER AVE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-1825
Practice Address - Country:US
Practice Address - Phone:631-786-4417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH009119225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist