Provider Demographics
NPI:1831272392
Name:BLACKWELL, LYNN SOBRAY (OTR)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:SOBRAY
Last Name:BLACKWELL
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:PO BOX 153735
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75915-3735
Mailing Address - Country:US
Mailing Address - Phone:713-614-6673
Mailing Address - Fax:
Practice Address - Street 1:402 S JOHN REDDITT DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3108
Practice Address - Country:US
Practice Address - Phone:936-632-2107
Practice Address - Fax:936-632-2108
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102133225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist