Provider Demographics
NPI:1386132587
Name:ALBERT, LYNN
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:ALBERT
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 1:24 IDYLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTHFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06472-1441
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:225 AMITY RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2206
Practice Address - Country:US
Practice Address - Phone:203-387-0076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000952224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT224Z00000XOtherOCCUPATIONAL THERAPY ASSISTANT