MEDICARE: MRS. NICOLE MELISSA LYONS OTR/L

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	OTL13106	MA

General Provider Information

NPI Number	:	1801294038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE MELISSA LYONS OTR/L

Provider Business Mailing Address
First Line	:	73 DAVIS RD
Second Line	:
City	:	STOUGHTON
State	:	MA
Zip	:	02072-3319
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	73 DAVIS RD
Second Line	:
City	:	STOUGHTON
State	:	MA
Zip	:	02072-3319
Country	:	US
Telephone Number	:	401-339-1311
Fax Number	:

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

Provider Enumeration Date	:	12/22/2014
Last Update Date	:	03/09/2026

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