Provider Demographics
NPI:1679334841
Name:LYON, JENNIFER (OTR)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LYON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10198 SILVER MAPLE CIR
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-5424
Mailing Address - Country:US
Mailing Address - Phone:720-272-9353
Mailing Address - Fax:
Practice Address - Street 1:9350 TEDDY LN
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-2876
Practice Address - Country:US
Practice Address - Phone:720-272-9353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1075156225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist