Provider Demographics
NPI:1265553218
Name:RAJTEROWSKI, LYNETTE MARIE (OT)
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:MARIE
Last Name:RAJTEROWSKI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:LYNETTE
Other - Middle Name:MARIE
Other - Last Name:MISKINIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:5404 WOODLEY LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-1531
Mailing Address - Country:US
Mailing Address - Phone:815-501-3261
Mailing Address - Fax:
Practice Address - Street 1:202 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1507
Practice Address - Country:US
Practice Address - Phone:608-417-5751
Practice Address - Fax:608-417-5315
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL56002607225X00000X
IL056-002607225XH1200X
WI6801225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand