Provider Demographics
NPI:1053378570
Name:LEWIS, ZENDA LYNN (OTR/L, CHT, CWCE,CLT)
Entity type:Individual
Prefix:MRS
First Name:ZENDA
Middle Name:LYNN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:OTR/L, CHT, CWCE,CLT
Other - Prefix:MS
Other - First Name:ZENDA
Other - Middle Name:LYNN
Other - Last Name:BRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L,CHT,CWCE,CLT
Mailing Address - Street 1:15555 N MISTY LN
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-7720
Mailing Address - Country:US
Mailing Address - Phone:217-868-5632
Mailing Address - Fax:
Practice Address - Street 1:1303 W EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-1619
Practice Address - Country:US
Practice Address - Phone:217-342-3400
Practice Address - Fax:217-342-9714
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056005236225XH1200X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist