MEDICARE: KRYSTINA LEIGH LANUTO MS, 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	009119	OH

General Provider Information

NPI Number	:	1992162838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTINA LEIGH LANUTO MS, OTR/L

Provider Business Mailing Address
First Line	:	780 LESTER AVE
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45801-1825
Country	:	US
Telephone Number	:	631-786-4417
Fax Number	:

Provider Business Practice Location Address
First Line	:	780 LESTER AVE
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45801-1825
Country	:	US
Telephone Number	:	631-786-4417
Fax Number	:

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

Provider Enumeration Date	:	01/22/2016
Last Update Date	:	01/22/2016

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