Provider Demographics
NPI:1033489364
Name:LILLY, LORRIE ANN (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:LORRIE
Middle Name:ANN
Last Name:LILLY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 HIGHWAY 22 E
Mailing Address - Street 2:
Mailing Address - City:OWENTON
Mailing Address - State:KY
Mailing Address - Zip Code:40359-9176
Mailing Address - Country:US
Mailing Address - Phone:502-514-3364
Mailing Address - Fax:
Practice Address - Street 1:905 HIGHWAY 127 N
Practice Address - Street 2:
Practice Address - City:OWENTON
Practice Address - State:KY
Practice Address - Zip Code:40359-9302
Practice Address - Country:US
Practice Address - Phone:502-484-0661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA4928224Z00000X
376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No376K00000XNursing Service Related ProvidersNurse's Aide