Provider Demographics
NPI:1003275686
Name:GEORGE, LISA (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6504 TENDER MIST MEWS
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-6026
Mailing Address - Country:US
Mailing Address - Phone:410-207-1689
Mailing Address - Fax:
Practice Address - Street 1:4400 JENIFER ST NW
Practice Address - Street 2:SUITE 280
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2113
Practice Address - Country:US
Practice Address - Phone:202-244-8089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOT987225XP0200X
MD04483225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics