Provider Demographics
NPI:1811043680
Name:SPRINGER, LYNETTE (OTRL, CLT)
Entity Type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:
Last Name:SPRINGER
Suffix:
Gender:F
Credentials:OTRL, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 75TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5637
Mailing Address - Country:US
Mailing Address - Phone:262-654-5961
Mailing Address - Fax:
Practice Address - Street 1:6308 8TH AVE STE 501
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-5031
Practice Address - Country:US
Practice Address - Phone:262-656-3299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4287-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist