Provider Demographics
NPI:1104860840
Name:BRUDNAK-KELLY, LYNN MARIE (OT, CHT)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:BRUDNAK-KELLY
Suffix:
Gender:F
Credentials:OT, CHT
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:MARIE
Other - Last Name:BRUDNAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT, CHT
Mailing Address - Street 1:435 TILDEN ST
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:PA
Mailing Address - Zip Code:15954-3030
Mailing Address - Country:US
Mailing Address - Phone:814-446-6777
Mailing Address - Fax:
Practice Address - Street 1:134 E MARKET ST
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15717-1326
Practice Address - Country:US
Practice Address - Phone:724-459-5101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC005275L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist