Provider Demographics
NPI:1366283699
Name:JAHNCKE, LYNN B (OT)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:B
Last Name:JAHNCKE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14133 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:LA
Mailing Address - Zip Code:70437-3301
Mailing Address - Country:US
Mailing Address - Phone:504-578-0069
Mailing Address - Fax:
Practice Address - Street 1:601 HOLY TRINITY DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-6230
Practice Address - Country:US
Practice Address - Phone:985-609-5850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z10009225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist