MEDICARE: JO A. LEWIS C.T.R.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225800000X	Recreation Therapist

General Provider Information

NPI Number	:	1013038603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JO A. LEWIS C.T.R.S.

Provider Business Mailing Address
First Line	:	828 CIMARRON CT
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-2542
Country	:	US
Telephone Number	:	863-646-2656
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 SLEEPY HILL RD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33810-3800
Country	:	US
Telephone Number	:	863-858-4402
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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