Provider Demographics
NPI:1093920100
Name:HARTZLER, LISA MARIE (MS)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:HARTZLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 CLEARMONT DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-4006
Mailing Address - Country:US
Mailing Address - Phone:773-859-1380
Mailing Address - Fax:
Practice Address - Street 1:9811 WOODS DR
Practice Address - Street 2:SUITE H-190
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1074
Practice Address - Country:US
Practice Address - Phone:847-663-2327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist