Provider Demographics
NPI:1114129285
Name:SHAFER, LYNN MICHELLE (MS, OTRL)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:MICHELLE
Last Name:SHAFER
Suffix:
Gender:F
Credentials:MS, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1462 TIMBER CHASE DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-9150
Mailing Address - Country:US
Mailing Address - Phone:717-728-9182
Mailing Address - Fax:
Practice Address - Street 1:55 MILLER STREET
Practice Address - Street 2:
Practice Address - City:SUMMERDALE
Practice Address - State:PA
Practice Address - Zip Code:17093
Practice Address - Country:US
Practice Address - Phone:717-732-8400
Practice Address - Fax:717-732-8414
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008067225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics