Healthcare Provider Details

I. General information

NPI: 1558275339
Provider Name (Legal Business Name): JUSTIN LEWIS MS OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19850 AL HIGHWAY 75
HENAGAR AL
35978-7459
US

IV. Provider business mailing address

PO BOX 148
HENAGAR AL
35978-0148
US

V. Phone/Fax

Practice location:
  • Phone: 256-717-4011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4391
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: