Provider Demographics
NPI:1497518617
Name:HARRIS, LYDIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:170 MIDDLING LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-3767
Mailing Address - Country:US
Mailing Address - Phone:470-884-9369
Mailing Address - Fax:
Practice Address - Street 1:1755 HIGHWAY 34 E STE 1300
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-3186
Practice Address - Country:US
Practice Address - Phone:770-254-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT009029225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist