Provider Demographics
NPI:1033178116
Name:STOVER, LYNELL PYLE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LYNELL
Middle Name:PYLE
Last Name:STOVER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WINGED FOOT CT
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901
Mailing Address - Country:US
Mailing Address - Phone:936-632-8780
Mailing Address - Fax:
Practice Address - Street 1:211 S TIMBERLAND
Practice Address - Street 2:REGIONAL PHYSICAL THERAPY
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901
Practice Address - Country:US
Practice Address - Phone:936-632-5511
Practice Address - Fax:936-632-5633
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100134225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX456703Medicare ID - Type Unspecified