Provider Demographics
NPI:1629587712
Name:DAMICO, LILLIAN F (OTR/L)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:F
Last Name:DAMICO
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 1:87 ROLLING GREEN DR
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-9700
Mailing Address - Country:US
Mailing Address - Phone:540-290-9158
Mailing Address - Fax:
Practice Address - Street 1:8840 CYPRESS WATERS BLVD, SUITE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75019
Practice Address - Country:US
Practice Address - Phone:469-524-5512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006847225X00000X
DCOT010001371225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist