Provider Demographics
NPI:1114130754
Name:HERRMANN, LISA LYN (MS OTR L)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LYN
Last Name:HERRMANN
Suffix:
Gender:F
Credentials:MS OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 E WESCOTT DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-2434
Mailing Address - Country:US
Mailing Address - Phone:602-441-5975
Mailing Address - Fax:602-485-8859
Practice Address - Street 1:1941 E WESCOTT DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-2434
Practice Address - Country:US
Practice Address - Phone:602-441-5975
Practice Address - Fax:602-485-8859
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2762225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist