Provider Demographics
NPI:1053532713
Name:FAIRBANKS, LYNSEY ZOE (OT)
Entity type:Individual
Prefix:MRS
First Name:LYNSEY
Middle Name:ZOE
Last Name:FAIRBANKS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:LYNSEY
Other - Middle Name:ZOE
Other - Last Name:HOOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11101 W GENZMAN RD
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:OH
Mailing Address - Zip Code:43449-9275
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 HELEN ST
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:OH
Practice Address - Zip Code:43410-2051
Practice Address - Country:US
Practice Address - Phone:419-547-4280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6085225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist