Provider Demographics
NPI:1003082637
Name:HERZBERG, LYNN ANNETTE (COTA/C)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:ANNETTE
Last Name:HERZBERG
Suffix:
Gender:F
Credentials:COTA/C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19451 DORADO DR
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-1610
Mailing Address - Country:US
Mailing Address - Phone:949-459-6277
Mailing Address - Fax:
Practice Address - Street 1:23293 S POINTE DR
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1447
Practice Address - Country:US
Practice Address - Phone:949-770-5843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-04
Last Update Date:2008-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1756224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant