Provider Demographics
NPI:1972083889
Name:LILLY, JOAN ELLEN (OTR/L CLWT)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:ELLEN
Last Name:LILLY
Suffix:
Gender:F
Credentials:OTR/L CLWT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 BRYANT AVE
Mailing Address - Street 2:
Mailing Address - City:CREIGHTON
Mailing Address - State:NE
Mailing Address - Zip Code:68729-2966
Mailing Address - Country:US
Mailing Address - Phone:402-358-0081
Mailing Address - Fax:
Practice Address - Street 1:1503 MAIN ST
Practice Address - Street 2:
Practice Address - City:CREIGHTON
Practice Address - State:NE
Practice Address - Zip Code:68729-3007
Practice Address - Country:US
Practice Address - Phone:402-358-5759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1066225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist