Basic Information
| Provider Information | |||||||||
| NPI: | 1154353803 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOWER | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | SHADEL | ||||||||
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| Credential: | OT | ||||||||
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| OtherLastName: | SHADEL | ||||||||
| OtherFirstName: | LYNN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5300 DERRY ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171113576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178392110 | ||||||||
| FaxNumber: | 7175651934 | ||||||||
| Practice Location | |||||||||
| Address1: | 3399 TRINDLE RD | ||||||||
| Address2: | FLOOR 2 | ||||||||
| City: | CAMP HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170114407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172303459 | ||||||||
| FaxNumber: | 7172303411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 04/04/2016 | ||||||||
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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 | OC005264L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | OC005264L | 01 | PA | LICENSE | OTHER |