Provider Demographics
NPI:1992924195
Name:CROTEAU, LYNN ANN (OTRL)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:ANN
Last Name:CROTEAU
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:ANN
Other - Last Name:BESEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6313 E ROLAND ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-0783
Mailing Address - Country:US
Mailing Address - Phone:480-686-8258
Mailing Address - Fax:
Practice Address - Street 1:7255 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85208-9201
Practice Address - Country:US
Practice Address - Phone:480-981-8844
Practice Address - Fax:480-325-4563
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3820225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist