Provider Demographics
NPI:1083072276
Name:BANKS, LYNN (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17800 ROSEWOOD TER
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60478-4527
Mailing Address - Country:US
Mailing Address - Phone:708-745-7122
Mailing Address - Fax:
Practice Address - Street 1:17800 ROSEWOOD TERRACE
Practice Address - Street 2:
Practice Address - City:COUNTRY CLUB HILLS
Practice Address - State:IL
Practice Address - Zip Code:60478
Practice Address - Country:US
Practice Address - Phone:708-745-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057 .003201224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant