Provider Demographics
NPI:1790813236
Name:LYNN, THERESA
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:LYNN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:CIRROTTI-LYNN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:421 EMPRESS LANE
Mailing Address - Street 2:
Mailing Address - City:CHULUOTA
Mailing Address - State:FL
Mailing Address - Zip Code:32766
Mailing Address - Country:US
Mailing Address - Phone:321-348-3631
Mailing Address - Fax:
Practice Address - Street 1:3403 TECHNOLOGICAL AVE.
Practice Address - Street 2:SUITE 2
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817
Practice Address - Country:US
Practice Address - Phone:407-681-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3514225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist