Provider Demographics
NPI:1326315953
Name:FLAVIN, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FLAVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-2944
Mailing Address - Country:US
Mailing Address - Phone:845-532-4765
Mailing Address - Fax:
Practice Address - Street 1:925 S SEMORAN BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-5313
Practice Address - Country:US
Practice Address - Phone:877-430-2772
Practice Address - Fax:800-521-9608
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant