Provider Demographics
NPI:1992945356
Name:LYONS, EDWARD P JR (COTA)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:P
Last Name:LYONS
Suffix:JR
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:N WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02191-1330
Mailing Address - Country:US
Mailing Address - Phone:781-803-2287
Mailing Address - Fax:
Practice Address - Street 1:426 ROOSEVELT DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:CT
Practice Address - Zip Code:06478-1740
Practice Address - Country:US
Practice Address - Phone:203-734-5353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA03212224Z00000X
CT000751224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant