Provider Demographics
NPI:1104043470
Name:BULONE, LISA MARIE (COTA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:BULONE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1844 WILLOWHILL LN
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-3770
Mailing Address - Country:US
Mailing Address - Phone:419-410-4554
Mailing Address - Fax:
Practice Address - Street 1:11080 E GYPSY LANE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-9564
Practice Address - Country:US
Practice Address - Phone:419-353-8411
Practice Address - Fax:419-352-9403
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2543224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant