Individual
MR. DOUGLAS LINCOLN LILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
111 FAYETTE AVE, FAYETTEVILLE, WV 25840-1219
(304) 574-1176
(304) 574-4109
Mailing address
111 FAYETTE AVE, FAYETTEVILLE, WV 25840-1219
(304) 574-1176
(304) 574-4109
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
895
WV
Other
Enumeration date
02/08/2008
Last updated
02/08/2008
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