Provider Demographics
NPI:1427204874
Name:BLAND, LISA KAYE (COTA/C)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:KAYE
Last Name:BLAND
Suffix:
Gender:F
Credentials:COTA/C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:KAYE
Other - Last Name:BLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA/C
Mailing Address - Street 1:5209 E THE TOLEDO
Mailing Address - Street 2:APARTMENT #2
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-1847
Mailing Address - Country:US
Mailing Address - Phone:562-508-6326
Mailing Address - Fax:
Practice Address - Street 1:5209 E THE TOLEDO
Practice Address - Street 2:APARTMENT #2
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-1847
Practice Address - Country:US
Practice Address - Phone:562-508-6326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1251224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant