MEDICARE: MRS. LYNDA JENNINGS 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	103794	TX

General Provider Information

NPI Number	:	1588817134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYNDA JENNINGS OTR

Provider Business Mailing Address
First Line	:	26423 WINDFALL
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78260-6296
Country	:	US
Telephone Number	:	210-381-1975
Fax Number	:

Provider Business Practice Location Address
First Line	:	THE VILLAGE AT INCARNATE WORD
Second Line	:	4707 BROADWAY
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209
Country	:	US
Telephone Number	:	210-829-7561
Fax Number	:	210-301-1540

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

Provider Enumeration Date	:	10/28/2008
Last Update Date	:	07/15/2020

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