Provider Demographics
NPI:1346394210
Name:WRIGHT, LISA MECHELLE (OTR)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MECHELLE
Last Name:WRIGHT
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 1:5002 HUNTERS POINT CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-1479
Mailing Address - Country:US
Mailing Address - Phone:502-448-3797
Mailing Address - Fax:
Practice Address - Street 1:329 TOWNEPARK CIR STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2348
Practice Address - Country:US
Practice Address - Phone:502-254-9524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R3347225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist