Provider Demographics
NPI:1316194269
Name:LYON, RENEE ANNE (MS, OTR)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:ANNE
Last Name:LYON
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11611 PINE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080-9225
Mailing Address - Country:US
Mailing Address - Phone:269-664-9206
Mailing Address - Fax:269-664-9295
Practice Address - Street 1:11611 PINE LAKE RD
Practice Address - Street 2:
Practice Address - City:PLAINWELL
Practice Address - State:MI
Practice Address - Zip Code:49080-9225
Practice Address - Country:US
Practice Address - Phone:269-664-9206
Practice Address - Fax:269-664-9295
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007138225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5201007138OtherSTATE OF MICHIGAN - DEBARTMENT OF COMMUNITY HEALTH - REGISTRATION
0002789OtherNBCOT