Provider Demographics
NPI:1588708986
Name:LYNN, MARY KATHLEEN (OTR)
Entity type:Individual
Prefix:PROF
First Name:MARY
Middle Name:KATHLEEN
Last Name:LYNN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6860 N AMAHL DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1211
Mailing Address - Country:US
Mailing Address - Phone:520-404-1547
Mailing Address - Fax:
Practice Address - Street 1:6860 N AMAHL DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1211
Practice Address - Country:US
Practice Address - Phone:520-404-1547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1075225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1075OtherAZ STATE BOARD OF OT EXAM
AA447300OtherNATIONAL OT BOARD