Provider Demographics
NPI:1366513756
Name:VISSOTSKI, LYNN M
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:VISSOTSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NORMAN DR
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-4239
Mailing Address - Country:US
Mailing Address - Phone:724-776-8478
Mailing Address - Fax:724-776-8596
Practice Address - Street 1:100 NORMAN DR
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-4239
Practice Address - Country:US
Practice Address - Phone:724-776-8478
Practice Address - Fax:724-776-8596
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002924L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist