Provider Demographics
NPI:1366316119
Name:LINCOLN, MARY GRACE (OTR/L)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:GRACE
Last Name:LINCOLN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 DUTTON DR
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-4310
Mailing Address - Country:US
Mailing Address - Phone:484-343-4412
Mailing Address - Fax:
Practice Address - Street 1:3135 DUTTON DR
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-4310
Practice Address - Country:US
Practice Address - Phone:484-343-4412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010060225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist