Healthcare Provider Details

I. General information

NPI: 1427753847
Provider Name (Legal Business Name): LYDIA LAWSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LACKAWANNA AVE
SCRANTON PA
18503-2001
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-209-7604
  • Fax: 570-207-5985
Mailing address:
  • Phone: 570-209-7604
  • Fax: 570-207-5985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC018333
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: