Provider Demographics
NPI:1164768396
Name:EVERSOLE, LISA (OTRL)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:EVERSOLE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16411 NE 24TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-2427
Mailing Address - Country:US
Mailing Address - Phone:425-456-5700
Mailing Address - Fax:425-456-5702
Practice Address - Street 1:16411 NE 24TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-2427
Practice Address - Country:US
Practice Address - Phone:425-456-5700
Practice Address - Fax:425-456-5702
Is Sole Proprietor?:No
Enumeration Date:2012-12-16
Last Update Date:2012-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics