Provider Demographics
NPI:1043419476
Name:QUAN, LYNN SUE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:SUE
Last Name:QUAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 S ATLANTIC BLVD
Mailing Address - Street 2:UNIT C
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-2750
Mailing Address - Country:US
Mailing Address - Phone:626-293-7553
Mailing Address - Fax:
Practice Address - Street 1:9320 TELSTAR AVE
Practice Address - Street 2:STE. 226
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2816
Practice Address - Country:US
Practice Address - Phone:626-293-7553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 2335222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist