Provider Demographics
NPI:1457552143
Name:DELASH, LYNN ANNE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:ANNE
Last Name:DELASH
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MISS
Other - First Name:LYNN
Other - Middle Name:ANNE
Other - Last Name:DAVIES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTRL
Mailing Address - Street 1:6807 WILD TURKEY DR
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553-7729
Mailing Address - Country:US
Mailing Address - Phone:540-582-3398
Mailing Address - Fax:
Practice Address - Street 1:1201 SAM PERRY BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4490
Practice Address - Country:US
Practice Address - Phone:540-741-1547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003909225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist