Provider Demographics
NPI:1891815668
Name:LYNKIEWICZ, LINDA KATHERINE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:KATHERINE
Last Name:LYNKIEWICZ
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 1:34700 BARTLETT RD
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4903
Mailing Address - Country:US
Mailing Address - Phone:262-424-1344
Mailing Address - Fax:
Practice Address - Street 1:2000 W BLUEMOUND RD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-2787
Practice Address - Country:US
Practice Address - Phone:262-896-3446
Practice Address - Fax:262-896-3450
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI87- 026225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40561500Medicaid