Provider Demographics
NPI:1629251020
Name:LILLIS, SHEENA LYNN (OTR/L)
Entity type:Individual
Prefix:
First Name:SHEENA
Middle Name:LYNN
Last Name:LILLIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SHEENA
Other - Middle Name:LYNN
Other - Last Name:PANONCILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:CONNELLY
Mailing Address - State:NY
Mailing Address - Zip Code:12417-0022
Mailing Address - Country:US
Mailing Address - Phone:850-814-1244
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 22
Practice Address - Street 2:
Practice Address - City:CONNELLY
Practice Address - State:NY
Practice Address - Zip Code:12417-0022
Practice Address - Country:US
Practice Address - Phone:850-814-1244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2025-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028819225X00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist