Provider Demographics
NPI:1346425956
Name:LINCOLN, AMY (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LINCOLN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 PINE DR
Mailing Address - Street 2:
Mailing Address - City:ACUSHNET
Mailing Address - State:MA
Mailing Address - Zip Code:02743-1932
Mailing Address - Country:US
Mailing Address - Phone:508-995-6351
Mailing Address - Fax:
Practice Address - Street 1:68 ALLISON AVE
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-6958
Practice Address - Country:US
Practice Address - Phone:508-880-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7903OtherMA OT LICENSE