Provider Demographics
NPI:1275608689
Name:LYONS, JILL L (OTR)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:L
Last Name:LYONS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 STATE PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:VT
Mailing Address - Zip Code:05445-9336
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4066 SHELBURNE RD
Practice Address - Street 2:SUITE NUMBER 8
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-6905
Practice Address - Country:US
Practice Address - Phone:802-985-8211
Practice Address - Fax:802-985-8733
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072-0000052225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist