Provider Demographics
NPI:1609323997
Name:FLYNN, THERESA (OTR/L)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:FLYNN
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 1:600 HIGHLAND AVE
Mailing Address - Street 2:MAIL STOP 2424
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53792-2424
Mailing Address - Country:US
Mailing Address - Phone:608-263-8060
Mailing Address - Fax:608-262-7679
Practice Address - Street 1:202 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715
Practice Address - Country:US
Practice Address - Phone:608-417-5751
Practice Address - Fax:608-417-5315
Is Sole Proprietor?:No
Enumeration Date:2016-09-05
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5903-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist