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General NPI Number Information
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NPI Number | 1245968270
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Entity Type | Individual
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Provider Name | KIMBERLY DIANNE LYON OTR
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Gender | Female
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Dates
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Enumeration Date | 08/09/2022
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 4940 W 56TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-1408
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Country | US
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Telephone | 317-297-3115
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Fax |
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Provider Business Mailing Address
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Address Line | 8659 N 275 E
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City | PITTSBORO
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State | IN
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Zip | 46167
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Country | US
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Telephone | 317-489-2810
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 1034464
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License Number State | IN
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