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General NPI Number Information
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NPI Number | 1396085148
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Entity Type | Individual
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Provider Name | LYNN ANN FARROW O.T.
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Gender | Female
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Dates
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Enumeration Date | 02/14/2013
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Last Update Date | 02/14/2013
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Provider Practice Location Address
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Address Line | 3073 S CHASE AVE SUITE 240
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City | MILWAUKEE
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State | WI
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Zip | 53207-2638
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Country | US
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Telephone | 414-231-4223
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Fax | 414-489-0540
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Provider Business Mailing Address
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Address Line | 3535 MOUNTAIN DR
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City | BROOKFIELD
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State | WI
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Zip | 53045-1443
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Country | US
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Telephone | 262-783-9890
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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 | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 1289-26
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License Number State | WI
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