Provider Demographics
NPI:1912400904
Name:LILLEY, WENDY L (RRT)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:L
Last Name:LILLEY
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:ILION
Mailing Address - State:NY
Mailing Address - Zip Code:13357-2131
Mailing Address - Country:US
Mailing Address - Phone:315-717-9600
Mailing Address - Fax:
Practice Address - Street 1:2150 BLEECKER ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-1738
Practice Address - Country:US
Practice Address - Phone:315-798-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007610227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered