Provider Demographics
NPI:1912236522
Name:BUYNACK, LORI JAYNE (OTR/L)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:JAYNE
Last Name:BUYNACK
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 1:1454 SCALP AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3321
Mailing Address - Country:US
Mailing Address - Phone:814-266-8833
Mailing Address - Fax:814-269-3385
Practice Address - Street 1:1454 SCALP AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3321
Practice Address - Country:US
Practice Address - Phone:814-266-8833
Practice Address - Fax:814-269-3385
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006219L171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor