=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144633918
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNN HARWELL OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2014
-----------------------------------------------------
Last Update Date | 06/30/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 625 OVERLOOK DR
-----------------------------------------------------
City | WINTER HAVEN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33884-1626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-229-5994
-----------------------------------------------------
Fax | 863-662-3926
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 685 CARMEL LN
-----------------------------------------------------
City | POINCIANA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34759-6119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-752-3071
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 13129
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------