Provider Demographics
NPI:1023544319
Name:LYONS, DANETTE (OTR)
Entity Type:Individual
Prefix:
First Name:DANETTE
Middle Name:
Last Name:LYONS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:DANNA
Other - Middle Name:
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6977 PROFESSIONAL PKWY E
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8411
Mailing Address - Country:US
Mailing Address - Phone:941-758-3140
Mailing Address - Fax:941-870-4891
Practice Address - Street 1:6977 PROFESSIONAL PKWY E
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34240
Practice Address - Country:US
Practice Address - Phone:941-758-3140
Practice Address - Fax:941-870-4891
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00778900225X00000X
FLOT18997225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist