MEDICARE: PHYLLIS LEWIS

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	225X00000X	Occupational Therapist		DC

General Provider Information

NPI Number	:	1255735197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS LEWIS

Provider Business Mailing Address
First Line	:	680 RHODE ISLAND AVE NE
Second Line	:	SUITE I
City	:	WASHINGTON
State	:	DC
Zip	:	20002-1269
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	680 RHODE ISLAND AVE NE
Second Line	:	SUITE I
City	:	WASHINGTON
State	:	DC
Zip	:	20002-1269
Country	:	US
Telephone Number	:	202-575-5404
Fax Number	:

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

Provider Enumeration Date	:	10/21/2014
Last Update Date	:	10/21/2014

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Directions to “ PHYLLIS LEWIS ” Practice Location

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