Provider Demographics
NPI:1093907123
Name:ADKINS, LISA (COTA/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ADKINS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 OLD AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-2007
Mailing Address - Country:US
Mailing Address - Phone:276-608-1378
Mailing Address - Fax:
Practice Address - Street 1:1666 HILLVIEW DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-4116
Practice Address - Country:US
Practice Address - Phone:423-542-5061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1715224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant