Basic Information
| Provider Information | |||||||||
| NPI: | 1023544319 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYONS | ||||||||
| FirstName: | DANETTE | ||||||||
| MiddleName: | |||||||||
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| Credential: | OTR | ||||||||
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| OtherLastName: | LYONS | ||||||||
| OtherFirstName: | DANNA | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6977 PROFESSIONAL PKWY E | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD RANCH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342408411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417583140 | ||||||||
| FaxNumber: | 9418704891 | ||||||||
| Practice Location | |||||||||
| Address1: | 6977 PROFESSIONAL PKWY E | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD RANCH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417583140 | ||||||||
| FaxNumber: | 9418704891 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2017 | ||||||||
| LastUpdateDate: | 12/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 46TR00778900 | NJ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | OT18997 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.