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General NPI Number Information
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NPI Number | 1366860082
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Entity Type | Individual
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Provider Name | LYNN RYANNE WEBER MOT, OTR
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Gender | Female
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Dates
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Enumeration Date | 03/31/2014
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Last Update Date | 08/06/2014
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Provider Practice Location Address
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Address Line | 7424 SHADELAND STATION WAY
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-3925
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Country | US
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Telephone | 317-288-7606
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Fax |
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Provider Business Mailing Address
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Address Line | 1572 WOODSON DR APT 249
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-1787
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Country | US
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Telephone | 708-359-5203
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Fax |
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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 | 31005656A
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License Number State | IN
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