Kevin D Lynn, COTA
Individual provider Active NPI Feeding, Eating & Swallowing Occupational Therapy Assistant · Payette, ID
NPI 1447594064 · NPPES record last updated Nov 20, 2012
Key facts
- NPI
- 1447594064
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Feeding, Eating & Swallowing Occupational Therapy Assistant 224ZF0002X
- License
- OTA-117 (ID)
- Practice address
- 1019 3Rd Ave S
Payette, ID 83661-2832 - Phone
- (208) 642-4455
- Fax
- (208) 642-1315
- NPI assigned
- Nov 20, 2012
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTA-117 | ID | MD | Feeding, Eating & Swallowing Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Environmental Modification Occupational Therapy Assistant | 224ZE0001X | OR | ||
| Feeding, Eating & Swallowing Occupational Therapy Assistant | 224ZF0002X | OTA-117 | ID | Yes |
Addresses
Primary practice location
1019 3Rd Ave S
Payette, ID 83661-2832
Mailing address
808 SW 8TH St
Fruitland, ID 83619-2527
Other providers in Payette, ID
- Megan Landen
- Brad W Levitt
- Janean Lewis
- Rebecca Jolene Long
- Jessica Ludwig
- Sara Elizabeth Manzer
- Todd William Martinez
- Holly M May
- Jared Mayer
- James H Moore
All providers in Payette, ID · Feeding, Eating & Swallowing Occupational Therapy Assistant in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.