Provider Demographics
NPI:1447918354
Name:LYONS, CASEY
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:LYONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 OSPREY RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-1605
Mailing Address - Country:US
Mailing Address - Phone:304-673-9077
Mailing Address - Fax:
Practice Address - Street 1:2789 PINE GROVE RD
Practice Address - Street 2:
Practice Address - City:LINDSIDE
Practice Address - State:WV
Practice Address - Zip Code:24951-7053
Practice Address - Country:US
Practice Address - Phone:304-673-9077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC2179224Z00000X
WV2245225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant