Provider Demographics
NPI:1740507037
Name:FAST, LYNNETTE SUE (OTR)
Entity type:Individual
Prefix:MRS
First Name:LYNNETTE
Middle Name:SUE
Last Name:FAST
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 ARMSTRONG RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-3906
Mailing Address - Country:US
Mailing Address - Phone:517-393-5680
Mailing Address - Fax:517-272-1085
Practice Address - Street 1:707 ARMSTRONG RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-3906
Practice Address - Country:US
Practice Address - Phone:517-393-5680
Practice Address - Fax:517-272-1085
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201002872225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist