Healthcare Provider Details

I. General information

NPI: 1831322270
Provider Name (Legal Business Name): STACY LYNN LYONS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11539 PARK WOODS CIR SUITE 502
ALPHARETTA GA
30005-4413
US

IV. Provider business mailing address

11539 PARK WOODS CIR SUITE 502
ALPHARETTA GA
30005-4413
US

V. Phone/Fax

Practice location:
  • Phone: 678-527-3224
  • Fax: 678-366-5886
Mailing address:
  • Phone: 678-527-3224
  • Fax: 678-366-5886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT004954
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: