Provider Demographics
NPI:1306193438
Name:ATIS, LA (COTA)
Entity Type:Individual
Prefix:MR
First Name:LA
Middle Name:
Last Name:ATIS
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:MR
Other - First Name:LIONEL
Other - Middle Name:
Other - Last Name:ATIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:1065 DAUPHIN LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-5929
Mailing Address - Country:US
Mailing Address - Phone:314-630-7326
Mailing Address - Fax:
Practice Address - Street 1:1065 DAUPHIN LN
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033
Practice Address - Country:US
Practice Address - Phone:314-630-7326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012006010224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant