Provider Demographics
NPI:1245968270
Name:LYON, KIMBERLY DIANNE (OTR)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DIANNE
Last Name:LYON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8659 N 275 E
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:IN
Mailing Address - Zip Code:46167
Mailing Address - Country:US
Mailing Address - Phone:317-489-2810
Mailing Address - Fax:
Practice Address - Street 1:4940 W 56TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-1408
Practice Address - Country:US
Practice Address - Phone:317-297-3115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1034464225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist