Provider Demographics
NPI:1306473574
Name:LEWIS, JOHN TERRENCE II (OTR/L)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:TERRENCE
Last Name:LEWIS
Suffix:II
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 RED MAPLE CT SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6719
Mailing Address - Country:US
Mailing Address - Phone:678-549-1487
Mailing Address - Fax:
Practice Address - Street 1:2305 RED MAPLE CT SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-6719
Practice Address - Country:US
Practice Address - Phone:678-549-1487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007679225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist