Provider Demographics
NPI:1336310564
Name:TRIOLO, LISA DOROTHY (MS OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DOROTHY
Last Name:TRIOLO
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 W HEATHER WOODS DR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-2685
Mailing Address - Country:US
Mailing Address - Phone:208-461-4882
Mailing Address - Fax:208-461-4882
Practice Address - Street 1:764 W HEATHER WOODS DR
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-2685
Practice Address - Country:US
Practice Address - Phone:208-461-4882
Practice Address - Fax:208-461-4882
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-16
Last Update Date:2008-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-808225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist