Provider Demographics
NPI:1396085148
Name:FARROW, LYNN ANN (OT)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:ANN
Last Name:FARROW
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:ANN
Other - Last Name:HOCKING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:3535 MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-1443
Mailing Address - Country:US
Mailing Address - Phone:262-783-9890
Mailing Address - Fax:
Practice Address - Street 1:3073 S CHASE AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-2638
Practice Address - Country:US
Practice Address - Phone:414-231-4223
Practice Address - Fax:414-489-0540
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1289-26302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1289-26OtherWISCONSIN OT LICENSE