Provider Demographics
NPI:1184828048
Name:POIRIER, LISA M (OTR, CHT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:POIRIER
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:P
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR, CHT
Mailing Address - Street 1:30 WASHINGTON ST
Mailing Address - Street 2:#2A
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-3200
Mailing Address - Country:US
Mailing Address - Phone:617-591-4652
Mailing Address - Fax:
Practice Address - Street 1:5 MIDDLESEX AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-1102
Practice Address - Country:US
Practice Address - Phone:617-591-4652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3591225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand