Provider Demographics
NPI:1043524259
Name:LYTLE AND ASSOCIATES SPECIALIZED THERAPY LLC
Entity Type:Organization
Organization Name:LYTLE AND ASSOCIATES SPECIALIZED THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LYTLE
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:740-264-7505
Mailing Address - Street 1:2700 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-1158
Mailing Address - Country:US
Mailing Address - Phone:740-264-7505
Mailing Address - Fax:740-264-7535
Practice Address - Street 1:2700 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-1158
Practice Address - Country:US
Practice Address - Phone:740-264-7505
Practice Address - Fax:740-264-7535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT004994225X00000X
OH1041100185225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9393321Medicare PIN
P00909840Medicare PIN