Organization Active NPI

Lily Clinic LLC

  • Occupational Therapist
  • Roanoke, VA
National Provider Identifier
1336030063
Registry record updated Jul 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
LILY CLINIC LLC
Practice address
4419 Pheasant Ridge Rd Ste 101
Roanoke, VA 24014-5267
Phone
(267) 474-1169
NPI assigned
Jul 11, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Matthew Cash, MS OTR/LNPI 1992411128
Title
Occupational Therapist
Phone
(267) 474-1169

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225X00000X Primary

Addresses

Primary practice location

4419 Pheasant Ridge Rd Ste 101
Roanoke, VA 24014-5267

Mailing address

3988 Alleghany Dr
Salem, VA 24153-1990
Phone (267) 474-1169

Other names 1

  • The Lily Clinic LLS Lymphedema, Vascular Health and Wellness Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250904001748 VA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0547762106 Receives reassigned benefits from 1 practitioner
Practice locations: Roanoke, VA

National Provider Directory

National Provider Directory

Locations

4419 Pheasant Ridge Rd
Ste 101
Roanoke, VA 24014
Phone (267) 474-1169

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1752192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752537600000",
    "number": "1336030063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3988 ALLEGHANY DR",
            "city": "SALEM",
            "state": "VA",
            "postal_code": "241531990",
            "telephone_number": "267-474-1169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4419 PHEASANT RIDGE RD STE 101",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240145267",
            "telephone_number": "267-474-1169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LILY CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-11",
        "last_updated": "2025-07-15",
        "certification_date": "2025-07-15",
        "status": "A",
        "authorized_official_last_name": "CASH",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPIST",
        "authorized_official_telephone_number": "267-474-1169",
        "authorized_official_credential": "MS OTR/L"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Lily Clinic LLS Lymphedema, Vascular Health and Wellness",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Lily Clinic LLS Lymphedema, Vascular Health and Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.