Basic Information
| Provider Information | |||||||||
| NPI: | 1265802896 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LYONS | ||||||||
| FirstName: | KELSEY | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | M.S., OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21254 BEACH BLVD | ||||||||
| Address2: | 201 | ||||||||
| City: | HUNTINGTON BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926485468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4125196263 | ||||||||
| FaxNumber: | 7149624159 | ||||||||
| Practice Location | |||||||||
| Address1: | 17075 BUSHARD ST | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927082836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8559017742 | ||||||||
| FaxNumber: | 7149624159 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2015 | ||||||||
| LastUpdateDate: | 09/24/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X | 15635 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.