Provider Demographics
NPI:1447570163
Name:BURNS, LYDIA BRYNN
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:BRYNN
Last Name:BURNS
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 1:1348 DRY BROOK CT
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-2832
Mailing Address - Country:US
Mailing Address - Phone:316-788-1212
Mailing Address - Fax:
Practice Address - Street 1:1348 DRY BROOK CT
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-2832
Practice Address - Country:US
Practice Address - Phone:316-788-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSPENDING224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant