Provider Demographics
NPI:1568620490
Name:SOSNOSKY, LYNN MARIE (OTR)
Entity Type:Individual
Prefix:MISS
First Name:LYNN
Middle Name:MARIE
Last Name:SOSNOSKY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:LYNN
Other - Middle Name:MARIE
Other - Last Name:SOSNOSKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:1331 SOUTH ONEIDA STREET
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915
Mailing Address - Country:US
Mailing Address - Phone:920-731-6646
Mailing Address - Fax:
Practice Address - Street 1:1335 S ONEIDA ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-1351
Practice Address - Country:US
Practice Address - Phone:920-731-6646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2420-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40814500Medicaid