Provider Demographics
NPI:1073777215
Name:LYTLE, HELEN GARDNER (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:HELEN
Middle Name:GARDNER
Last Name:LYTLE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 ARTHUR MODLIN RD
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27846-9785
Mailing Address - Country:US
Mailing Address - Phone:252-217-5080
Mailing Address - Fax:252-789-4006
Practice Address - Street 1:2550 ARTHUR MODLIN RD
Practice Address - Street 2:
Practice Address - City:JAMESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27846-9785
Practice Address - Country:US
Practice Address - Phone:252-217-5080
Practice Address - Fax:252-789-4006
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5117225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist