Provider Demographics
NPI:1427397918
Name:HEBERT-MERITT, LISA MARIE (COTA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:HEBERT-MERITT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 N SPRING DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-2544
Mailing Address - Country:US
Mailing Address - Phone:540-562-4146
Mailing Address - Fax:
Practice Address - Street 1:5369 PETERS CREEK RD NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-3849
Practice Address - Country:US
Practice Address - Phone:540-278-1322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000079224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant