Provider Demographics
NPI:1194225383
Name:LYON, RACHEAL MARIE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:RACHEAL
Middle Name:MARIE
Last Name:LYON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MISS
Other - First Name:RACHEAL
Other - Middle Name:MARIE
Other - Last Name:REESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/LL
Mailing Address - Street 1:2250 DORCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-5653
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:186 W BATH RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-2516
Practice Address - Country:US
Practice Address - Phone:330-922-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.004980225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$OtherSOCIAL SECURITY OFFICE