Provider Demographics
NPI:1891150546
Name:LYLE, CAMERON RYE (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:CAMERON
Middle Name:RYE
Last Name:LYLE
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 WINTERS HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:ERIN
Mailing Address - State:TN
Mailing Address - Zip Code:37061-6822
Mailing Address - Country:US
Mailing Address - Phone:931-801-2328
Mailing Address - Fax:
Practice Address - Street 1:380 WINTERS HOLLOW LN
Practice Address - Street 2:
Practice Address - City:ERIN
Practice Address - State:TN
Practice Address - Zip Code:37061-6822
Practice Address - Country:US
Practice Address - Phone:931-241-7509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2086225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics