Provider Demographics
NPI:1316310352
Name:LWIN, LYNNETTE KELLY (OTR)
Entity type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:KELLY
Last Name:LWIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:LYNNETTE
Other - Middle Name:MARIE
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:91-1325 KUANOO ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-4718
Mailing Address - Country:US
Mailing Address - Phone:808-384-5966
Mailing Address - Fax:
Practice Address - Street 1:91-1325 KUANOO ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-4718
Practice Address - Country:US
Practice Address - Phone:808-384-5966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOT182225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist