1801227301 NPI number — LYNN OCCUPATIONAL THERAPY, LLC.

Table of content: (NPI 1801227301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801227301 NPI number — LYNN OCCUPATIONAL THERAPY, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LYNN OCCUPATIONAL THERAPY, LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801227301
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1003 BURLEW BOULEVARD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
OWENSBORO
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-688-8449
Provider Business Mailing Address Fax Number:
270-240-4840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1003 BURLEW BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-688-8449
Provider Business Practice Location Address Fax Number:
270-240-4840
Provider Enumeration Date:
12/09/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LYNN
Authorized Official First Name:
DALE
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
OCCUPATIONAL THREAPIST
Authorized Official Telephone Number:
270-688-8449

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  005369 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X , with the licence number: 134498 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , with the licence number: 142037 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7100271900 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".