Provider Demographics
NPI:1225147150
Name:SORENSEN-CHANUTIN, LISA MARION (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARION
Last Name:SORENSEN-CHANUTIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:MARION
Other - Last Name:SORENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:11947 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411
Mailing Address - Country:US
Mailing Address - Phone:561-204-2213
Mailing Address - Fax:561-204-2218
Practice Address - Street 1:11947 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411
Practice Address - Country:US
Practice Address - Phone:561-204-2213
Practice Address - Fax:561-204-2218
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT1879225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT1879OtherOT LINCENSE