Healthcare Provider Details

I. General information

NPI: 1245151067
Provider Name (Legal Business Name): LILY PERKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 MONTAGUE WAY
ROANOKE VA
24018-7698
US

IV. Provider business mailing address

5340 MONTAGUE WAY
ROANOKE VA
24018-7698
US

V. Phone/Fax

Practice location:
  • Phone: 540-797-8916
  • Fax:
Mailing address:
  • Phone: 540-797-8916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119010839
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: