Provider Demographics
NPI:1912103409
Name:DEWITT, LYNN MARIE (OTR)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:DEWITT
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 1:1307 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-4454
Mailing Address - Country:US
Mailing Address - Phone:903-874-6265
Mailing Address - Fax:903-641-0626
Practice Address - Street 1:1307 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-4454
Practice Address - Country:US
Practice Address - Phone:903-874-6265
Practice Address - Fax:903-641-0626
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004947225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist