Provider Demographics
NPI:1699034413
Name:LEWIS, RYAN PAUL (OTR/L)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:PAUL
Last Name:LEWIS
Suffix:
Gender:M
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 1:1965 N STONEY POINT CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-6498
Mailing Address - Country:US
Mailing Address - Phone:316-312-0281
Mailing Address - Fax:316-729-8175
Practice Address - Street 1:1965 N STONEY POINT CT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-6498
Practice Address - Country:US
Practice Address - Phone:316-312-0281
Practice Address - Fax:316-729-8175
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-02035225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist