Provider Demographics
NPI:1447696414
Name:FLYNN, SALLY JEAN (OTR)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:JEAN
Last Name:FLYNN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:JEAN
Other - Last Name:MCLEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:2213 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-3103
Mailing Address - Country:US
Mailing Address - Phone:916-452-1038
Mailing Address - Fax:
Practice Address - Street 1:2213 3RD AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-3103
Practice Address - Country:US
Practice Address - Phone:916-452-1038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5046225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist