Provider Demographics
NPI:1336396191
Name:MAXWELL, LUCY-LYNN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:LUCY-LYNN
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:LUCY-LYNN
Other - Middle Name:
Other - Last Name:MAXWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PO BOX 954
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:KY
Mailing Address - Zip Code:40831-0954
Mailing Address - Country:US
Mailing Address - Phone:606-909-4576
Mailing Address - Fax:606-573-4030
Practice Address - Street 1:36 MEADOW DR
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831-3538
Practice Address - Country:US
Practice Address - Phone:606-909-4576
Practice Address - Fax:606-573-4030
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-24
Last Update Date:2008-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R1877225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist