MEDICARE: MARY LYNN ANNIBALE OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	009075	OH

General Provider Information

NPI Number	:	1821561754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY LYNN ANNIBALE OTR/L

Provider Business Mailing Address
First Line	:	237 LEATHERMAN RD
Second Line	:
City	:	WADSWORTH
State	:	OH
Zip	:	44281-9236
Country	:	US
Telephone Number	:	330-336-2120
Fax Number	:

Provider Business Practice Location Address
First Line	:	237 LEATHERMAN RD
Second Line	:
City	:	WADSWORTH
State	:	OH
Zip	:	44281-9236
Country	:	US
Telephone Number	:	330-336-2120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2019
Last Update Date	:	03/08/2026

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