=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205161841
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNN ANN DUNAY OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2009
-----------------------------------------------------
Last Update Date | 10/15/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 53 GRAVEL STREET
-----------------------------------------------------
City | WILKES-BARRE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18705-3738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-371-5600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 71 W HARTFORD STREET
-----------------------------------------------------
City | ASHLEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-820-0242
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | OC004446L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------