Provider Demographics
NPI:1083964936
Name:LYONS, PAMELA JANE (OTR/L)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JANE
Last Name:LYONS
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 1:4720 NE 139TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-2204
Mailing Address - Country:US
Mailing Address - Phone:360-574-0198
Mailing Address - Fax:
Practice Address - Street 1:4855 EVERGREEN WAY
Practice Address - Street 2:WASHOUGAL SCHOOL DISTRICT,
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671
Practice Address - Country:US
Practice Address - Phone:360-954-3020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 00000160225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics