Basic Information
| Provider Information | |||||||||
| NPI: | 1083833354 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | JONES | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 W NORTH BLVD | ||||||||
| Address2: | SUITE D | ||||||||
| City: | LEESBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347485063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527879300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 W NORTH BLVD | ||||||||
| Address2: | SUITE D | ||||||||
| City: | LEESBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347485063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527879300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT0000464 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 883769400 | 05 | FL | MEDICAID |