Provider Demographics
NPI:1659586907
Name:LYON, MICHELLE R (CMT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:LYON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13023 GRANT CIR E
Mailing Address - Street 2:#A
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-2428
Mailing Address - Country:US
Mailing Address - Phone:303-778-1131
Mailing Address - Fax:303-778-0809
Practice Address - Street 1:405 S PLATTE RIVER DR
Practice Address - Street 2:#1B
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80223-2069
Practice Address - Country:US
Practice Address - Phone:303-778-0809
Practice Address - Fax:303-778-0809
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist