Provider Demographics
NPI:1689796898
Name:LYNCH FANNON, ANGELA (OT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:LYNCH FANNON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 PLACID CREEK LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-8400
Mailing Address - Country:US
Mailing Address - Phone:410-800-8763
Mailing Address - Fax:
Practice Address - Street 1:600A VILLAGE WALK DR
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-4438
Practice Address - Country:US
Practice Address - Phone:919-285-2157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10287225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist