Provider Demographics
NPI:1235262700
Name:SLAYBAUGH, LYNETTE MICHELE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:MICHELE
Last Name:SLAYBAUGH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:LYNETTE
Other - Middle Name:MICHELE
Other - Last Name:BOOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:4413 WARWICK CV
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-8295
Mailing Address - Country:US
Mailing Address - Phone:479-790-9138
Mailing Address - Fax:
Practice Address - Street 1:4413 WARWICK CV
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-8295
Practice Address - Country:US
Practice Address - Phone:479-790-9138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1083225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y909OtherBLUE CROSS BLUE SHIELD