Provider Demographics
NPI:1710523550
Name:FLYNN, LANE ANN (OT)
Entity Type:Individual
Prefix:
First Name:LANE
Middle Name:ANN
Last Name:FLYNN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1166 MARYLAND ROUTE 3 S STE 109
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1773
Mailing Address - Country:US
Mailing Address - Phone:410-451-5700
Mailing Address - Fax:410-451-5703
Practice Address - Street 1:8717 GREENBELT RD STE 102
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2480
Practice Address - Country:US
Practice Address - Phone:301-552-2371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08892225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist