Provider Demographics
NPI:1033996376
Name:CANNON-STEWART, LISA ANNA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANNA
Last Name:CANNON-STEWART
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:ANNA
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:1701 EXCHANGE AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73108-3020
Mailing Address - Country:US
Mailing Address - Phone:405-587-0000
Mailing Address - Fax:
Practice Address - Street 1:1701 EXCHANGE AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-3020
Practice Address - Country:US
Practice Address - Phone:405-587-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK575225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist