MEDICARE: KAYLA NICOLE LYNUM

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	224Z00000X	Occupational Therapy Assistant	521191	WI

General Provider Information

NPI Number	:	1578382123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA NICOLE LYNUM

Provider Business Mailing Address
First Line	:	149 250TH ST
Second Line	:
City	:	WOODVILLE
State	:	WI
Zip	:	54028-7218
Country	:	US
Telephone Number	:	715-977-2333
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 CHERRY AVE W
Second Line	:
City	:	PLUM CITY
State	:	WI
Zip	:	54761-9781
Country	:	US
Telephone Number	:	715-647-2401
Fax Number	:

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

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	10/09/2024

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