Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 419 | MT |
NPI | 1013118710 |
---|---|
Provider Name | Mrs. Delene R Lynes |
First Address | Great Falls, MT 59404-3406 |
Second Address | Great Falls, MT 59405-5161 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 08/07/2007 |