=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891815668
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA KATHERINE LYNKIEWICZ O.T.R.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 W BLUEMOUND RD
-----------------------------------------------------
City | WAUKESHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53186-2787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-896-3446
-----------------------------------------------------
Fax | 262-896-3450
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 34700 BARTLETT RD
-----------------------------------------------------
City | OCONOMOWOC
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53066-4903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-424-1344
-----------------------------------------------------
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 | 87- 026
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------