Provider Demographics
NPI:1396043451
Name:EBERSOLE, CYNTHIA LYONS (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LYONS
Last Name:EBERSOLE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:SALFORDVILLE
Mailing Address - City:SALFORDVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18958-0143
Mailing Address - Country:US
Mailing Address - Phone:610-405-2996
Mailing Address - Fax:
Practice Address - Street 1:32 S BETHLEHEM PIKE
Practice Address - Street 2:AMBLER
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-5801
Practice Address - Country:US
Practice Address - Phone:610-405-2996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC001489L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist