Provider Demographics
NPI:1366821050
Name:GILMORE, LISA G (OTR/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:G
Last Name:GILMORE
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 1:211 W SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2745
Mailing Address - Country:US
Mailing Address - Phone:315-335-4305
Mailing Address - Fax:
Practice Address - Street 1:211 W SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2745
Practice Address - Country:US
Practice Address - Phone:315-335-4305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist