Provider Demographics
NPI:1235147471
Name:PURRENHAGE, LISA ANN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:PURRENHAGE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31638 STRICKER DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-2935
Mailing Address - Country:US
Mailing Address - Phone:586-415-9392
Mailing Address - Fax:586-415-9392
Practice Address - Street 1:8200 S SAGINAW ST
Practice Address - Street 2:STE 200
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1843
Practice Address - Country:US
Practice Address - Phone:810-603-3841
Practice Address - Fax:810-603-3871
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006281225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist