Provider Demographics
NPI:1013303338
Name:FLYNN, LAUREN KINGSLEY (OTR/L)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:KINGSLEY
Last Name:FLYNN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22502 SAMBAR LOOP
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-5377
Mailing Address - Country:US
Mailing Address - Phone:907-726-4663
Mailing Address - Fax:844-605-1820
Practice Address - Street 1:3170 M ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2403
Practice Address - Country:US
Practice Address - Phone:209-723-1056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15173225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist