Provider Demographics
NPI:1588817134
Name:JENNINGS, LYNDA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:
Other - Last Name:HEIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:26423 WINDFALL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-6296
Mailing Address - Country:US
Mailing Address - Phone:210-381-1975
Mailing Address - Fax:
Practice Address - Street 1:THE VILLAGE AT INCARNATE WORD
Practice Address - Street 2:4707 BROADWAY
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209
Practice Address - Country:US
Practice Address - Phone:210-829-7561
Practice Address - Fax:210-301-1540
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103794225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist