Basic Information
| Provider Information | |||||||||
| NPI: | 1841801248 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LYNCH | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | LCOTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 KENSINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485035312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8109657640 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13137 N CLIO RD | ||||||||
| Address2: | |||||||||
| City: | CLIO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484201028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106862600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2020 | ||||||||
| LastUpdateDate: | 08/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 5202006942 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.