Provider Demographics
NPI:1780691188
Name:JAMES, LYLA BROOKE (CTRS)
Entity type:Individual
Prefix:
First Name:LYLA
Middle Name:BROOKE
Last Name:JAMES
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5013 WEEMS ST
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39563-2657
Mailing Address - Country:US
Mailing Address - Phone:228-475-0570
Mailing Address - Fax:228-475-0570
Practice Address - Street 1:400 VETERANS AVE # 135
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2410
Practice Address - Country:US
Practice Address - Phone:228-523-5789
Practice Address - Fax:228-523-5789
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS52642225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist