1336396191 NPI number — MS. LUCY-LYNN MAXWELL OTR/L

Table of content: MS. LUCY-LYNN MAXWELL OTR/L (NPI 1336396191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336396191 NPI number — MS. LUCY-LYNN MAXWELL OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAXWELL
Provider First Name:
LUCY-LYNN
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAXWELL
Provider Other First Name:
LUCY-LYNN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/L
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1336396191
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 954
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARLAN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40831-0954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-909-4576
Provider Business Mailing Address Fax Number:
606-573-4030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36 MEADOW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLAN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40831-3538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-909-4576
Provider Business Practice Location Address Fax Number:
606-573-4030
Provider Enumeration Date:
08/24/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  KY-R1877 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)