Provider Demographics
NPI:1619219599
Name:DUBREUIL, LYNN ELLEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ELLEN
Last Name:DUBREUIL
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 1:23 LIBERTY WAY
Mailing Address - Street 2:
Mailing Address - City:NIANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357-1030
Mailing Address - Country:US
Mailing Address - Phone:860-739-4007
Mailing Address - Fax:
Practice Address - Street 1:23 LIBERTY WAY
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-1030
Practice Address - Country:US
Practice Address - Phone:860-739-4007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2516225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist