Provider Demographics
NPI:1023563350
Name:SCHENK, LISA (COTA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SCHENK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 BUSH RD
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-5694
Mailing Address - Country:US
Mailing Address - Phone:561-354-9805
Mailing Address - Fax:561-354-9815
Practice Address - Street 1:350 BUSH RD
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5694
Practice Address - Country:US
Practice Address - Phone:561-354-9805
Practice Address - Fax:561-354-9815
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 8044224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant