Provider Demographics
NPI:1245708783
Name:MARCUM, LYNSEY ERIN (BS, COTA/L)
Entity type:Individual
Prefix:
First Name:LYNSEY
Middle Name:ERIN
Last Name:MARCUM
Suffix:
Gender:F
Credentials:BS, COTA/L
Other - Prefix:
Other - First Name:LYNSEY
Other - Middle Name:
Other - Last Name:MILBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:215 S HURSTBOURNE PKWY STE 213
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4937
Practice Address - Country:US
Practice Address - Phone:502-353-2074
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY245747224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant