Provider Demographics
NPI:1023573474
Name:LEBOEUF, LISA NUNNALLY (COTA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:NUNNALLY
Last Name:LEBOEUF
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:NUNNALLY
Other - Last Name:LEBOEUF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:11830 NORTHPOINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-5536
Mailing Address - Country:US
Mailing Address - Phone:281-205-9400
Mailing Address - Fax:
Practice Address - Street 1:11830 NORTHPOINTE BLVD
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-5536
Practice Address - Country:US
Practice Address - Phone:713-822-1485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
210531224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant