Provider Demographics
NPI:1215987698
Name:SHIH, LYNN ANN (OT)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:ANN
Last Name:SHIH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:ANN
Other - Last Name:BOULANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3760 CONVOY ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3743
Mailing Address - Country:US
Mailing Address - Phone:888-208-8526
Mailing Address - Fax:858-751-0901
Practice Address - Street 1:1020 TIERRA DEL REY STE A1
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7886
Practice Address - Country:US
Practice Address - Phone:619-585-7104
Practice Address - Fax:619-585-7106
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 8553225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOT8553AMedicare ID - Type Unspecified