Provider Demographics
NPI:1932354826
Name:LYNCH, TARA ANNE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:ANNE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:ANNE
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:167 SACKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1106
Mailing Address - Country:US
Mailing Address - Phone:516-359-9824
Mailing Address - Fax:
Practice Address - Street 1:120 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2710
Practice Address - Country:US
Practice Address - Phone:516-237-2946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011106225XP0200X, 251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics