Basic Information
| Provider Information | |||||||||
| NPI: | 1053509489 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KNULL | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 760 CHESHAM CT | ||||||||
| Address2: | |||||||||
| City: | HARTLAND | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530292513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2623699351 | ||||||||
| FaxNumber: | 2623699351 | ||||||||
| Practice Location | |||||||||
| Address1: | 1451 CLEVELAND AVE | ||||||||
| Address2: | |||||||||
| City: | WAUKESHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531863876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625472123 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2007 | ||||||||
| LastUpdateDate: | 10/10/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 2657-26 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.