Provider Demographics
NPI:1366939928
Name:LYNCH, AMBER (OIT)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:OIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8777 PURDUE RD STE 330
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3121
Mailing Address - Country:US
Mailing Address - Phone:800-603-6046
Mailing Address - Fax:317-884-3388
Practice Address - Street 1:25 GLENLAKE PKWY
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-3403
Practice Address - Country:US
Practice Address - Phone:470-278-2254
Practice Address - Fax:317-884-3388
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004010225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOT004010OtherGEORGIA STATE OCCUPATIONAL THERAPY LICENSE