Provider Demographics
NPI:1801808860
Name:LYTLE, LISA M (OT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:LYTLE
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 1:2700 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-1158
Mailing Address - Country:US
Mailing Address - Phone:740-264-7505
Mailing Address - Fax:740-264-7535
Practice Address - Street 1:2700 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-1158
Practice Address - Country:US
Practice Address - Phone:740-264-7505
Practice Address - Fax:740-264-7535
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT004994225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH532615OtherHEALTH ASSURANCE
OH000000490545OtherANTHEM BLUE CROSS AND BLUE SHIELD
OH532615OtherHEALTH ASSURANCE
OH204560504OtherTAX ID NUMBER
OHLY4190511Medicare PIN