Provider Demographics
NPI:1568065613
Name:BEVARD, LILLIAN (LMT)
Entity Type:Individual
Prefix:MS
First Name:LILLIAN
Middle Name:
Last Name:BEVARD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SHALIMAR DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1977
Mailing Address - Country:US
Mailing Address - Phone:740-392-2004
Mailing Address - Fax:740-879-2151
Practice Address - Street 1:1 SHALIMAR DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-1977
Practice Address - Country:US
Practice Address - Phone:740-392-2004
Practice Address - Fax:740-879-2151
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.024851225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH33.024851OtherOHIO MEDICAL BOARD