Provider Demographics
NPI:1407103377
Name:GARCIA, LISA MARIE (OT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 W SESAME DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7962
Mailing Address - Country:US
Mailing Address - Phone:956-428-5440
Mailing Address - Fax:956-428-3375
Practice Address - Street 1:595 W SESAME DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7962
Practice Address - Country:US
Practice Address - Phone:956-230-1605
Practice Address - Fax:956-428-3375
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114942225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114942OtherTEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS