Provider Demographics
NPI:1073849311
Name:LUNN, MARY O'BRIEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:O'BRIEN
Last Name:LUNN
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 1:221 FORT MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:FT MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2622
Mailing Address - Country:US
Mailing Address - Phone:859-341-6760
Mailing Address - Fax:859-694-7669
Practice Address - Street 1:221 FORT MITCHELL AVE
Practice Address - Street 2:
Practice Address - City:FT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41011-2622
Practice Address - Country:US
Practice Address - Phone:859-341-6760
Practice Address - Fax:859-694-7669
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRO112225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist