Provider Demographics
NPI:1417408923
Name:LYNCH, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:LYNCH
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 1:791 WYLIE ST SE
Mailing Address - Street 2:UNIT 710
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-7200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:791 WYLIE ST SE
Practice Address - Street 2:UNIT 710
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-7200
Practice Address - Country:US
Practice Address - Phone:231-690-2745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005404225X00000X
MI5201007837225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist