Provider Demographics
NPI:1639681505
Name:DAIGLER, LYNN (ITDS CERTIFICATE)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:DAIGLER
Suffix:
Gender:F
Credentials:ITDS CERTIFICATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 LAUREL RD EAST # 334
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275
Mailing Address - Country:US
Mailing Address - Phone:260-450-0473
Mailing Address - Fax:
Practice Address - Street 1:1070 LAUREL RD E # 334
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-4500
Practice Address - Country:US
Practice Address - Phone:260-450-0473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-31
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist