Provider Demographics
NPI:1487843421
Name:LAWSON, VICTORIA LEE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:LEE
Last Name:LAWSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MAIN ST
Mailing Address - Street 2:P.O. BOX 214
Mailing Address - City:OPHIEM
Mailing Address - State:IL
Mailing Address - Zip Code:61468-9501
Mailing Address - Country:US
Mailing Address - Phone:309-629-8902
Mailing Address - Fax:
Practice Address - Street 1:11210 95TH ST
Practice Address - Street 2:
Practice Address - City:COAL VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61240-9360
Practice Address - Country:US
Practice Address - Phone:309-799-3161
Practice Address - Fax:309-799-5904
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility