Provider Demographics
NPI:1922541390
Name:LYONS, JORDAN ASHLEY (COTA/L)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ASHLEY
Last Name:LYONS
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 1:1205 OCEAN AVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:NORTH WILDWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08260-5656
Mailing Address - Country:US
Mailing Address - Phone:609-435-0708
Mailing Address - Fax:
Practice Address - Street 1:144 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:CAPE MAY CH
Practice Address - State:NJ
Practice Address - Zip Code:08210-2141
Practice Address - Country:US
Practice Address - Phone:609-465-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09133500224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant