Provider Demographics
NPI:1801227301
Name:LYNN OCCUPATIONAL THERAPY, LLC.
Entity Type:Organization
Organization Name:LYNN OCCUPATIONAL THERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THREAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:270-688-8449
Mailing Address - Street 1:1003 BURLEW BOULEVARD
Mailing Address - Street 2:SUITE C
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303
Mailing Address - Country:US
Mailing Address - Phone:270-688-8449
Mailing Address - Fax:270-240-4840
Practice Address - Street 1:1003 BURLEW BOULEVARD
Practice Address - Street 2:SUITE C
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303
Practice Address - Country:US
Practice Address - Phone:270-688-8449
Practice Address - Fax:270-240-4840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005369225100000X
KY134498225XP0200X
KY142037235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100271900Medicaid