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General NPI Number Information
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NPI Number | 1306999099
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Entity Type | Individual
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Provider Name | SUSAN MARY LYNEIS-SIRIAS OT
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Gender | Female
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 01/11/2011
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Provider Practice Location Address
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Address Line | 252 N. MAIN STREET
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City | ANGELS CAMP
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State | CA
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Zip | 95222-0278
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Country | US
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Telephone | 209-736-9589
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Fax | 209-728-8938
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Provider Business Mailing Address
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Address Line | 182 SWEETWATER DR
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City | MURPHYS
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State | CA
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Zip | 95247-9425
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Country | US
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Telephone | 209-728-8938
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Fax | 209-728-8938
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT5244
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License Number State | CA
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