Provider Demographics
NPI:1598939597
Name:LEWIS, JUDITH W (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:W
Last Name:LEWIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 ASHLEIGH LN
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-3920
Mailing Address - Country:US
Mailing Address - Phone:912-704-5779
Mailing Address - Fax:
Practice Address - Street 1:351 WILMINGTON ISLAND RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-3851
Practice Address - Country:US
Practice Address - Phone:912-898-9711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004475225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOT004475OtherOCCUPATIONAL THERAPY STATE BOARD