Provider Demographics
NPI:1982189569
Name:LYON, CAITLIN M (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:M
Last Name:LYON
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:
Other - Last Name:WOODWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:3808 WOOD RD
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:ID
Mailing Address - Zip Code:83455-5352
Mailing Address - Country:US
Mailing Address - Phone:208-240-2820
Mailing Address - Fax:
Practice Address - Street 1:1420 N HIGHWAY 33 STE 106
Practice Address - Street 2:
Practice Address - City:DRIGGS
Practice Address - State:ID
Practice Address - Zip Code:83422-5313
Practice Address - Country:US
Practice Address - Phone:208-240-2820
Practice Address - Fax:208-656-5647
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-1526225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDIDTPID012938Medicaid