Provider Demographics
NPI:1811153026
Name:FODOR, LYNETTE
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:
Last Name:FODOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYNETTE
Other - Middle Name:
Other - Last Name:HANCZAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:417 W CALL ST
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-3115
Mailing Address - Country:US
Mailing Address - Phone:904-964-4464
Mailing Address - Fax:904-964-4279
Practice Address - Street 1:417 W CALL ST
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-3115
Practice Address - Country:US
Practice Address - Phone:904-964-4464
Practice Address - Fax:904-964-4279
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics