Provider Demographics
NPI:1407090939
Name:LISENBE, SHANA LEIGH (MOTR)
Entity Type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:LEIGH
Last Name:LISENBE
Suffix:
Gender:F
Credentials:MOTR
Other - Prefix:MS
Other - First Name:SHANA
Other - Middle Name:L
Other - Last Name:SELBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR
Mailing Address - Street 1:7003 WOODWAY DR
Mailing Address - Street 2:SUITE 313
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6170
Mailing Address - Country:US
Mailing Address - Phone:254-399-6422
Mailing Address - Fax:
Practice Address - Street 1:7003 WOODWAY DR
Practice Address - Street 2:SUITE 313
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6170
Practice Address - Country:US
Practice Address - Phone:254-399-6422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX238716225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist