Provider Demographics
NPI:1285009530
Name:RYAN, LISA (OTR/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:RYAN
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 1:28 DEL BONIS DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:RI
Mailing Address - Zip Code:02892-1175
Mailing Address - Country:US
Mailing Address - Phone:401-225-2767
Mailing Address - Fax:
Practice Address - Street 1:150 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2914
Practice Address - Country:US
Practice Address - Phone:401-225-2767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10989225X00000X
RI01534225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist