Provider Demographics
NPI:1407944754
Name:SHOOMAN, LISA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SHOOMAN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 DUNBAR ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2017
Mailing Address - Country:US
Mailing Address - Phone:781-363-3684
Mailing Address - Fax:781-784-3946
Practice Address - Street 1:26 DUNBAR ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-2017
Practice Address - Country:US
Practice Address - Phone:781-784-7464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5849225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110084279AMedicaid
MA0005498OtherMEDICARE PTAN