MEDICARE: MARY O'BRIEN LUNN OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	RO112	KY

General Provider Information

NPI Number	:	1073849311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY O'BRIEN LUNN OTR/L

Provider Business Mailing Address
First Line	:	221 FORT MITCHELL AVE
Second Line	:
City	:	FT MITCHELL
State	:	KY
Zip	:	41011-2622
Country	:	US
Telephone Number	:	859-341-6760
Fax Number	:	859-694-7669

Provider Business Practice Location Address
First Line	:	221 FORT MITCHELL AVE
Second Line	:
City	:	FT MITCHELL
State	:	KY
Zip	:	41011-2622
Country	:	US
Telephone Number	:	859-341-6760
Fax Number	:	859-694-7669

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2009
Last Update Date	:	10/21/2009

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