Individual
KEVIN D LYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
1019 3RD AVE S, PAYETTE, ID 83661-2832
(208) 642-4455
(208) 642-1315
Mailing address
808 SW 8TH ST, FRUITLAND, ID 83619-2527
Taxonomy
Speciality
Code
Description
License number
State
224ZE0001X
Environmental Modification Occupational Therapy Assistant
—
OR
224ZF0002X
Feeding, Eating & Swallowing Occupational Therapy Assistant
Primary
OTA-117
ID
Other
Enumeration date
11/20/2012
Last updated
11/20/2012
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