Provider Demographics
NPI:1962017053
Name:DONNELLY, LYNN (MS,OTR/L)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3073 MITCHELL PASTURE LN
Mailing Address - Street 2:
Mailing Address - City:ELON
Mailing Address - State:NC
Mailing Address - Zip Code:27244-8012
Mailing Address - Country:US
Mailing Address - Phone:845-781-3834
Mailing Address - Fax:
Practice Address - Street 1:4434 OLD BATTLEGROUND RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9828
Practice Address - Country:US
Practice Address - Phone:845-781-3834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13180225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist