Provider Demographics
NPI:1942997119
Name:MCA'NULTY, LYNSEY (OTA)
Entity Type:Individual
Prefix:
First Name:LYNSEY
Middle Name:
Last Name:MCA'NULTY
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 FLORAL AVE
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-1537
Mailing Address - Country:US
Mailing Address - Phone:978-420-9874
Mailing Address - Fax:
Practice Address - Street 1:4 MILITIA DR STE 18
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-4714
Practice Address - Country:US
Practice Address - Phone:781-861-0695
Practice Address - Fax:781-861-0829
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4856224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant