Provider Demographics
NPI:1386193522
Name:GAHN, LISA (COTA/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GAHN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:9570 JOHN WERNER DR
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-9411
Mailing Address - Country:US
Mailing Address - Phone:740-491-2623
Mailing Address - Fax:
Practice Address - Street 1:824 S HURON ST
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-2210
Practice Address - Country:US
Practice Address - Phone:231-627-4347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202008074225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist