Provider Demographics
NPI:1790058337
Name:LYNN, RENAE SUE (OTR/L)
Entity Type:Individual
Prefix:
First Name:RENAE
Middle Name:SUE
Last Name:LYNN
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 1:607 NEBRASKA ST
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NE
Mailing Address - Zip Code:68733-3627
Mailing Address - Country:US
Mailing Address - Phone:402-695-2683
Mailing Address - Fax:402-695-2188
Practice Address - Street 1:607 NEBRASKA ST
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:NE
Practice Address - Zip Code:68733-3627
Practice Address - Country:US
Practice Address - Phone:402-695-2683
Practice Address - Fax:402-695-2188
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE728225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025599000Medicaid