Provider Demographics
NPI:1518922376
Name:PANICO, LYNN MARIE (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:PANICO
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FAWN MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06471-1484
Mailing Address - Country:US
Mailing Address - Phone:203-315-5071
Mailing Address - Fax:
Practice Address - Street 1:61 AMITY RD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1401
Practice Address - Country:US
Practice Address - Phone:203-389-8177
Practice Address - Fax:203-387-9447
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000391225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand