Provider Demographics
NPI:1285862979
Name:BEADLES, LYNETTE RAE (OTR)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:RAE
Last Name:BEADLES
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 1:16981 PLACER HILLS RD - B-7
Mailing Address - Street 2:
Mailing Address - City:MEADOW VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:95722
Mailing Address - Country:US
Mailing Address - Phone:530-878-8129
Mailing Address - Fax:530-878-8195
Practice Address - Street 1:16981 PLACER HILLS RD - B-7
Practice Address - Street 2:
Practice Address - City:MEADOW VISTA
Practice Address - State:CA
Practice Address - Zip Code:95722
Practice Address - Country:US
Practice Address - Phone:530-878-8129
Practice Address - Fax:530-878-8195
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89503225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist