Healthcare Provider Details

I. General information

NPI: 1780454520
Provider Name (Legal Business Name): LYNSEY LORAINE DAVIS OTD, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNSEY LORAINE STRESE

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 E COPELAND RD STE 300
ARLINGTON TX
76011-4910
US

IV. Provider business mailing address

6418 FISHER RD APT 107
DALLAS TX
75214-1612
US

V. Phone/Fax

Practice location:
  • Phone: 817-505-2575
  • Fax:
Mailing address:
  • Phone: 214-707-8584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number123784
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: