Lynnlee Fullenwider, OTR L CHT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT00000365 Issued in WA

Practice address

12911-120TH Ave. NE,
Suite F-120
Kirkland, WA 98034-3025

Phone

(425) 823-1389

Fax

(425) 820-3996

NPI assigned

Mar 7, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 6

Other names 1

• Ms. Lynnlee Olin Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eastside Hand Rehabilitation Clinic Inc

  • Occupational Therapist
  • Kirkland, WA
  • NPI 1467582320
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330473600000",
    "number": "1285764043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12911-120TH AVE. NE,",
            "address_2": "SUITE F-120",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343025",
            "telephone_number": "425-823-1389",
            "fax_number": "425-820-3996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12911-120TH AVE. NE,",
            "address_2": "SUITE F-120",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343025",
            "telephone_number": "425-823-1389",
            "fax_number": "425-820-3996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLENWIDER",
        "first_name": "LYNNLEE",
        "name_prefix": "Mrs.",
        "credential": "OTR L CHT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-07",
        "last_updated": "2012-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WA",
            "license": "OT00000365",
            "primary": true
        },
        {
            "code": "225XH1200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Hand",
            "state": "WA",
            "license": "9105000003",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I",
            "identifier": "0282315",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I",
            "identifier": "0282300",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I",
            "identifier": "0282323",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I",
            "identifier": "34464",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7680697",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "FU4123",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LYNNLEE",
            "last_name": "OLIN",
            "prefix": "MS.",
            "credential": "OTR L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Occupational Therapist in Kirkland, WA
• Providers in Kirkland, WA by specialty
• Occupational Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.