Provider Demographics
NPI:1174204010
Name:ANZIVINO, KARLA LEVERING (OTD)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:LEVERING
Last Name:ANZIVINO
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 W 14TH ST # UP
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-5215
Mailing Address - Country:US
Mailing Address - Phone:740-816-8285
Mailing Address - Fax:
Practice Address - Street 1:23775 GREENLAWN AVE
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-1430
Practice Address - Country:US
Practice Address - Phone:216-223-8761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT012524225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist