Provider Demographics
NPI:1124256441
Name:ROBERTS, LYNNE ANNE (OTR/L)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:ANNE
Last Name:ROBERTS
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 1:21 HOMESTEAD RD E
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1029
Mailing Address - Country:US
Mailing Address - Phone:315-732-8942
Mailing Address - Fax:
Practice Address - Street 1:21 HOMESTEAD RD E
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1029
Practice Address - Country:US
Practice Address - Phone:315-732-8942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002904-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency