Basic Information
| Provider Information | |||||||||
| NPI: | 1992228472 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LILLIS | ||||||||
| FirstName: | SYDNEY | ||||||||
| MiddleName: | ALYX | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 322 E COLLEEN DR | ||||||||
| Address2: | |||||||||
| City: | GARDNER | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660301903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137103624 | ||||||||
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| Practice Location | |||||||||
| Address1: | 480 S ROGERS RD | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660621706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133243849 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2017 | ||||||||
| LastUpdateDate: | 03/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 2017027152 | MO | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 17-03320 | KS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.