Healthcare Provider Details

I. General information

NPI: 1164257945
Provider Name (Legal Business Name): LYNNLEIGH OTWELL M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12820 W PARMER LN APT 9306
CEDAR PARK TX
78613-7540
US

IV. Provider business mailing address

12820 W PARMER LN APT 9306
CEDAR PARK TX
78613-7540
US

V. Phone/Fax

Practice location:
  • Phone: 318-517-9765
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number123060
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: