Provider Demographics
NPI:1730303033
Name:JANSKY, LYNN M (OTR)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:M
Last Name:JANSKY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 WALLENS RIDGE BLVD W
Mailing Address - Street 2:APT. 2
Mailing Address - City:BIG STONE GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24219-2759
Mailing Address - Country:US
Mailing Address - Phone:541-880-4342
Mailing Address - Fax:
Practice Address - Street 1:1401 BRYANT WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-7151
Practice Address - Country:US
Practice Address - Phone:541-882-6691
Practice Address - Fax:541-885-4515
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR242685225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR278773Medicaid