Provider Demographics
NPI:1134323157
Name:ADAMS, LISA MARIE (BSOT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:BSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 AUDUBON LN
Mailing Address - Street 2:
Mailing Address - City:FLAGLER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32136-4918
Mailing Address - Country:US
Mailing Address - Phone:386-439-8433
Mailing Address - Fax:386-439-8432
Practice Address - Street 1:250 OLD KINGS ROAD SOUTH
Practice Address - Street 2:
Practice Address - City:FLAGLER BEACH
Practice Address - State:FL
Practice Address - Zip Code:32136
Practice Address - Country:US
Practice Address - Phone:386-439-8433
Practice Address - Fax:386-439-8432
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT-1441225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist