1366302473 NPI number — MANUAL LYMPHATIC DRAINAGE & LYMPHEDEMA OCCUPATIONAL THERAPY, PLLC

Table of content: (NPI 1366302473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366302473 NPI number — MANUAL LYMPHATIC DRAINAGE & LYMPHEDEMA OCCUPATIONAL THERAPY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANUAL LYMPHATIC DRAINAGE & LYMPHEDEMA OCCUPATIONAL THERAPY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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NPI Number Information

NPI Number:
1366302473
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 LEACH HOLLOW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHERMAN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06784-2300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-402-0184
Provider Business Mailing Address Fax Number:
860-402-0184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 LEACH HOLLOW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHERMAN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06784-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-402-0184
Provider Business Practice Location Address Fax Number:
860-402-0184
Provider Enumeration Date:
11/12/2025

Additional Information

Authorized Official

Authorized Official Last Name:
LOMBARDO
Authorized Official First Name:
LYNETTE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OCCUPATIONAL THERAPIST
Authorized Official Telephone Number:
860-402-0184

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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