Provider Demographics
NPI:1487960811
Name:SCHRUM, LYNN (OTA)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:SCHRUM
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12472 LAKE UNDERHILL RD
Mailing Address - Street 2:#167
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12472 LAKE UNDERHILL RD
Practice Address - Street 2:#167
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7144
Practice Address - Country:US
Practice Address - Phone:321-373-3027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10307224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10307OtherOTA