Provider Demographics
NPI:1992228472
Name:LILLIS, SYDNEY ALYX (OTR/L)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:ALYX
Last Name:LILLIS
Suffix:
Gender:F
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 1:322 E COLLEEN DR
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-1903
Mailing Address - Country:US
Mailing Address - Phone:913-710-3624
Mailing Address - Fax:
Practice Address - Street 1:480 S ROGERS RD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1706
Practice Address - Country:US
Practice Address - Phone:913-324-3849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-03320225X00000X
MO2017027152225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist