Provider Demographics
NPI:1770522120
Name:LYONS, BONNY J (OT)
Entity type:Individual
Prefix:
First Name:BONNY
Middle Name:J
Last Name:LYONS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 INDIAN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-3916
Mailing Address - Country:US
Mailing Address - Phone:830-228-5444
Mailing Address - Fax:
Practice Address - Street 1:5835 CALLAGHAN RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1125
Practice Address - Country:US
Practice Address - Phone:210-344-4700
Practice Address - Fax:210-344-4734
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109003174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D4194Medicare ID - Type Unspecified