Healthcare Provider Details

I. General information

NPI: 1982661765
Provider Name (Legal Business Name): LORNA LOUISE NETUPSKY-LANG OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ATTN: CREDENTIALS OFFICE CMR 442
APO AE
09042
US

IV. Provider business mailing address

CMR 445 BOX 59
APO AE
09046
US

V. Phone/Fax

Practice location:
  • Phone: 496221172274
  • Fax: 496221172941
Mailing address:
  • Phone: 497031152697
  • Fax: 497031152765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number731
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: