Provider Demographics
NPI:1922379031
Name:LYLES, ALLISON TOMBLIN (COTA/L)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:TOMBLIN
Last Name:LYLES
Suffix:
Gender:F
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 1:201 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SPINDALE
Mailing Address - State:NC
Mailing Address - Zip Code:28160-1504
Mailing Address - Country:US
Mailing Address - Phone:828-429-1964
Mailing Address - Fax:
Practice Address - Street 1:1499 US HIGHWAY 74A BYP
Practice Address - Street 2:
Practice Address - City:SPINDALE
Practice Address - State:NC
Practice Address - Zip Code:28160-1873
Practice Address - Country:US
Practice Address - Phone:828-429-1964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant