Healthcare Provider Details

I. General information

NPI: 1457266264
Provider Name (Legal Business Name): LYNNE FARRELL LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4652 WILKENS AVE
BALTIMORE MD
21229-4842
US

IV. Provider business mailing address

2004 ELAINE AVE
HALETHORPE MD
21227-1848
US

V. Phone/Fax

Practice location:
  • Phone: 410-242-2748
  • Fax:
Mailing address:
  • Phone: 410-599-8763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM02446
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: