Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | 21973 | MA |
N | 225000000X | Orthotic Fitter | CFM00962 | MA |
NPI | 1811098684 |
---|---|
Provider Name | Delores Lynch |
First Address | Swansea, MA 02777 |
Second Address | Swansea, MA 02777 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1538411 | (05) | MA |
382454 | BCBS (01) | MA |
645163 | HARVARD PILGRIM (01) | |
78568 | BCBS (01) | RI |
DS24649 | (05) | RI |