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NPI Code Detail

MEDICARE: SHAYNE N LEWIS MOT

MEDICARE: SHAYNE N LEWIS MOT
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
1225X00000XOccupational Therapist2020033416MO
2225X00000XOccupational Therapist056013632IL

General Provider Information

NPI Number : 1467082560
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAYNE N LEWIS MOT
Provider Business Mailing Address
First Line : 600 OAKMONT LN STE 600C
Second Line :
City : WESTMONT
State : IL
Zip : 60559-5581
Country : US
Telephone Number : 630-575-1980
Fax Number :
Provider Business Practice Location Address
First Line : 1140 COLLINSVILLE CROSSING BLVD
Second Line :
City : COLLINSVILLE
State : IL
Zip : 62234-1880
Country : US
Telephone Number : 618-578-5901
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2020
Last Update Date : 12/05/2025

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