Provider Demographics
NPI:1982943965
Name:LYONS, LESLEY LYNN (COTA/L)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:LYNN
Last Name:LYONS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23802 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BARTON
Mailing Address - State:MD
Mailing Address - Zip Code:21521-2247
Mailing Address - Country:US
Mailing Address - Phone:301-707-7688
Mailing Address - Fax:
Practice Address - Street 1:1 KAYLOR CIR
Practice Address - Street 2:
Practice Address - City:FROSTBURG
Practice Address - State:MD
Practice Address - Zip Code:21532-2009
Practice Address - Country:US
Practice Address - Phone:301-689-7446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA01776224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant