Provider Demographics
NPI:1235949405
Name:GEORGE, LYDIA ANN (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:LYDIA
Middle Name:ANN
Last Name:GEORGE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2465 GLEBE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3129
Mailing Address - Country:US
Mailing Address - Phone:347-752-3974
Mailing Address - Fax:
Practice Address - Street 1:2465 GLEBE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3129
Practice Address - Country:US
Practice Address - Phone:347-752-3974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029777225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist