Provider Demographics
NPI:1487954640
Name:LANG, CYNTHIA ANNE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:ANNE
Last Name:LANG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:ANNE
Other - Last Name:GILLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2627 SPEAR POINT CT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-2578
Mailing Address - Country:US
Mailing Address - Phone:770-855-7862
Mailing Address - Fax:
Practice Address - Street 1:1475 HOLCOMB BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2139
Practice Address - Country:US
Practice Address - Phone:678-591-3542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000057225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist