Provider Demographics
NPI:1700442845
Name:LAMERE, LYDIA ELAINE (ATC)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:ELAINE
Last Name:LAMERE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:ELAINE
Other - Last Name:RICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:3215 SOUTTER AVE SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-3149
Mailing Address - Country:US
Mailing Address - Phone:319-423-1264
Mailing Address - Fax:
Practice Address - Street 1:1330 ELMHURST DR NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4763
Practice Address - Country:US
Practice Address - Phone:319-423-1264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0007762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer