Provider Demographics
NPI:1053664920
Name:FOSS, LISA KAY (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:KAY
Last Name:FOSS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:KAY
Other - Last Name:GRUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28900 HICKORY LODGE DR
Mailing Address - Street 2:
Mailing Address - City:VAN METER
Mailing Address - State:IA
Mailing Address - Zip Code:50261-6033
Mailing Address - Country:US
Mailing Address - Phone:515-996-9280
Mailing Address - Fax:
Practice Address - Street 1:28900 HICKORY LODGE DR
Practice Address - Street 2:
Practice Address - City:VAN METER
Practice Address - State:IA
Practice Address - Zip Code:50261-6033
Practice Address - Country:US
Practice Address - Phone:515-996-9280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00015225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist