Provider Demographics
NPI:1437244324
Name:LIGHTNER, BILLIE
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:
Last Name:LIGHTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-2025
Mailing Address - Country:US
Mailing Address - Phone:814-946-0220
Mailing Address - Fax:
Practice Address - Street 1:501 VALLEY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-6410
Practice Address - Country:US
Practice Address - Phone:814-944-5014
Practice Address - Fax:814-944-6500
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP001884L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000023490012Medicaid
PA396621Medicare ID - Type Unspecified