MEDICARE: MRS. LYNDA GAIL CORTES OTR

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	OT16508	FL
2	252Y00000X	Early Intervention Provider Agency	OT16508	FL
3	225X00000X	Occupational Therapist	OT24004	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245548635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYNDA GAIL CORTES OTR

Provider Business Mailing Address
First Line	:	13223 BLACK MOUNTAIN RD STE 1358
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-2698
Country	:	US
Telephone Number	:	858-753-5082
Fax Number	:

Provider Business Practice Location Address
First Line	:	13223 BLACK MOUNTAIN RD STE 1358
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-2698
Country	:	US
Telephone Number	:	609-847-9353
Fax Number	:

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

Provider Enumeration Date	:	09/20/2010
Last Update Date	:	09/14/2022

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