Provider Demographics
NPI:1043753981
Name:IFFLAND, LISA KAY (OTR)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:KAY
Last Name:IFFLAND
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 W GLADYS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4806
Mailing Address - Country:US
Mailing Address - Phone:312-733-8018
Mailing Address - Fax:773-481-8892
Practice Address - Street 1:2417 W GLADYS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4806
Practice Address - Country:US
Practice Address - Phone:312-733-8018
Practice Address - Fax:773-481-8892
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-26
Last Update Date:2016-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-001297225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics