Provider Demographics
NPI:1841476454
Name:LETOURNEAU, LYNDA YVONNE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:YVONNE
Last Name:LETOURNEAU
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:YVONNE
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:165 CURTIS MILES RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:NC
Mailing Address - Zip Code:28701-9762
Mailing Address - Country:US
Mailing Address - Phone:828-279-5442
Mailing Address - Fax:828-683-2004
Practice Address - Street 1:1063 HAYWOOD RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806
Practice Address - Country:US
Practice Address - Phone:828-285-8814
Practice Address - Fax:828-285-9144
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2245225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1841476454Medicaid
NCQ521690281OtherPTAN. PROVIDER TRANSACTION ACCESS NUMBER