MEDICARE: LYNN M FRIEBEL 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	225XP0200X	Pediatric Occupational Therapist	0001593	CT
2	225X00000X	Occupational Therapist	001953	CT

General Provider Information

NPI Number	:	1548298193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN M FRIEBEL OTR/L

Provider Business Mailing Address
First Line	:	1 RESERVOIR OFFICE PARK STE 104
Second Line	:	1449 OLD WATERBURY ROAD
City	:	SOUTHBURY
State	:	CT
Zip	:	06488-3926
Country	:	US
Telephone Number	:	203-262-9909
Fax Number	:	203-262-9911

Provider Business Practice Location Address
First Line	:	1 RESERVOIR OFFICE PARK STE 104
Second Line	:	1449 OLD WATERBURY ROAD
City	:	SOUTHBURY
State	:	CT
Zip	:	06488-3926
Country	:	US
Telephone Number	:	203-262-9909
Fax Number	:	203-262-9911

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	01/13/2014

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