Provider Demographics
NPI:1205206695
Name:KREJCI, LISA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:KREJCI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 BOALCH AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-7994
Mailing Address - Country:US
Mailing Address - Phone:425-888-2777
Mailing Address - Fax:
Practice Address - Street 1:1407 BOALCH AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-7994
Practice Address - Country:US
Practice Address - Phone:425-888-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 15231225X00000X
WAOT61014543225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist