Healthcare Provider Details

I. General information

NPI: 1356515340
Provider Name (Legal Business Name): LYN CAROL BLANK CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYN CAROL SCHNEEBAUM CTRS

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

IV. Provider business mailing address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-7000
  • Fax: 305-575-3369
Mailing address:
  • Phone: 305-575-7000
  • Fax: 305-575-3369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number16283
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: