Provider Demographics
NPI:1336458850
Name:WAINESS, LYNN MILGROM (OTR)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:MILGROM
Last Name:WAINESS
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 1:105 MARVIN WAY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-4932
Mailing Address - Country:US
Mailing Address - Phone:510-418-1921
Mailing Address - Fax:
Practice Address - Street 1:105 MARVIN WAY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-4932
Practice Address - Country:US
Practice Address - Phone:510-418-1921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1724225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist