Provider Demographics
NPI:1619249885
Name:WASHOCK, LYNN M (COTA)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:M
Last Name:WASHOCK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WOODBINE AVE
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-3819
Mailing Address - Country:US
Mailing Address - Phone:518-273-8151
Mailing Address - Fax:
Practice Address - Street 1:30 SOUTHGATE RD
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12211-1132
Practice Address - Country:US
Practice Address - Phone:518-785-6607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001312224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY224Z00000XOtherOCCUPATIONAL THERAPY ASSISTANT