Provider Demographics
NPI:1598235434
Name:BRENNAN, LYNN A (OTR)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:A
Last Name:BRENNAN
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 1:24749 SWAN RD
Mailing Address - Street 2:
Mailing Address - City:ST MICHAELS
Mailing Address - State:MD
Mailing Address - Zip Code:21663-2321
Mailing Address - Country:US
Mailing Address - Phone:732-599-5745
Mailing Address - Fax:
Practice Address - Street 1:24749 SWAN RD
Practice Address - Street 2:
Practice Address - City:ST MICHAELS
Practice Address - State:MD
Practice Address - Zip Code:21663-2321
Practice Address - Country:US
Practice Address - Phone:732-599-5745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06738225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist