MEDICARE: JILL L. LYONS OTR

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	072-0000052	VT

General Provider Information

NPI Number	:	1275608689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL L. LYONS OTR

Provider Business Mailing Address
First Line	:	150 STATE PARK RD
Second Line	:
City	:	CHARLOTTE
State	:	VT
Zip	:	05445-9336
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4066 SHELBURNE RD
Second Line	:	SUITE NUMBER 8
City	:	SHELBURNE
State	:	VT
Zip	:	05482-6905
Country	:	US
Telephone Number	:	802-985-8211
Fax Number	:	802-985-8733

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	07/08/2007

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