1457656357 NPI number — MS. LYNNE M MCCULLOCH OTR,MAC,LCAC

Table of content: MS. LYNNE M MCCULLOCH OTR,MAC,LCAC (NPI 1457656357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457656357 NPI number — MS. LYNNE M MCCULLOCH OTR,MAC,LCAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCULLOCH
Provider First Name:
LYNNE
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTR,MAC,LCAC
Provider Gender Code:
F

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:
1457656357
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1138 S HIGH SCHOOL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46241-3122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-241-9644
Provider Business Mailing Address Fax Number:
317-241-9730

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6531 W WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46241-3026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-241-9644
Provider Business Practice Location Address Fax Number:
317-241-9730
Provider Enumeration Date:
01/24/2011

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: 101YA0400X , with the licence number:  87000236A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com