Provider Demographics
NPI:1336356351
Name:LACKOFF, LYNN T (OT)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:T
Last Name:LACKOFF
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WALDOBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04572-5733
Mailing Address - Country:US
Mailing Address - Phone:207-594-5933
Mailing Address - Fax:
Practice Address - Street 1:116 TILLSON AVENUE
Practice Address - Street 2:KNOX COUNTY CDS
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841
Practice Address - Country:US
Practice Address - Phone:207-594-5933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME342411225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist