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General NPI Number Information
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NPI Number | 1811318017
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Entity Type | Individual
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Provider Name | MRS. LISA MARIE LANTZ
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Gender | Female
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Dates
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Enumeration Date | 12/15/2013
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Last Update Date | 12/15/2013
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Provider Practice Location Address
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Address Line | 339 E MAPLE ST STE 100
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City | CANTON
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State | OH
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Zip | 44720-2593
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Country | US
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Telephone | 330-498-8205
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Fax |
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Provider Business Mailing Address
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Address Line | 3533 FRANKLIN RD
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City | STOW
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State | OH
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Zip | 44224-4020
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Country | US
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Telephone | 330-203-9533
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA.05625
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License Number State | OH
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