Provider Demographics
NPI:1235430307
Name:POOLE, LYNDA MARIE (OTR)
Entity Type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:MARIE
Last Name:POOLE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 CHURCHILL LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-2541
Mailing Address - Country:US
Mailing Address - Phone:315-637-8834
Mailing Address - Fax:
Practice Address - Street 1:4725 ENDERS RD
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-9718
Practice Address - Country:US
Practice Address - Phone:315-692-1500
Practice Address - Fax:315-692-1053
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005809-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics