Healthcare Provider Details

I. General information

NPI: 1922286483
Provider Name (Legal Business Name): LYNNE OBERLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 LAKE SHORE DR W
DUNKIRK NY
14048-1437
US

IV. Provider business mailing address

200 DUNHAM AVE
JAMESTOWN NY
14701-2528
US

V. Phone/Fax

Practice location:
  • Phone: 716-366-6125
  • Fax:
Mailing address:
  • Phone: 716-661-1408
  • Fax: 716-661-1074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC002268L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number021950
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: