Provider Demographics
NPI:1740945393
Name:HENRY, LYDIA C (OTR/L)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:C
Last Name:HENRY
Suffix:
Gender:
Credentials:OTR/L
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:MAY
Other - Last Name:CLEMENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1647 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-4827
Mailing Address - Country:US
Mailing Address - Phone:229-520-7018
Mailing Address - Fax:
Practice Address - Street 1:1647 TERRACE DR
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-4827
Practice Address - Country:US
Practice Address - Phone:229-520-7018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7083225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist