Provider Demographics
NPI:1457776973
Name:EADIE, LYNN (OTR/L)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:EADIE
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 1:12625 DUSTY WHEEL LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1736
Mailing Address - Country:US
Mailing Address - Phone:703-615-6553
Mailing Address - Fax:
Practice Address - Street 1:12625 DUSTY WHEEL LN
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1736
Practice Address - Country:US
Practice Address - Phone:703-615-6553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 15189225X00000X
VA0119001284225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist