Provider Demographics
NPI:1134685837
Name:HEYWARD, LYNETTE JEAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:JEAN
Last Name:HEYWARD
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 1:2015 SWEETGUM TRL
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-5988
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2450 ATLANTA HWY STE 1001
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-1252
Practice Address - Country:US
Practice Address - Phone:404-834-8404
Practice Address - Fax:678-456-3437
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist