Provider Demographics
NPI:1285185629
Name:HEFNER, LYNN
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:HEFNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 OLD SHADY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:TN
Mailing Address - Zip Code:37357-7669
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 OLD SHADY GROVE RD
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:TN
Practice Address - Zip Code:37357-7669
Practice Address - Country:US
Practice Address - Phone:931-743-8431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2797224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant