Provider Demographics
NPI:1821133075
Name:LINCOLN, EDINAH H (OTR)
Entity Type:Individual
Prefix:MS
First Name:EDINAH
Middle Name:H
Last Name:LINCOLN
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 1:1721 W GOVERNOR ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-1550
Mailing Address - Country:US
Mailing Address - Phone:217-787-5769
Mailing Address - Fax:217-787-5769
Practice Address - Street 1:1721 W GOVERNOR ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-1550
Practice Address - Country:US
Practice Address - Phone:217-787-5769
Practice Address - Fax:217-787-5769
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-004774225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08432010OtherBLUE CROSS BLUE SHIELD
IL735348OtherHEALTHLINK
IL08432010OtherBLUE CROSS BLUE SHIELD