Provider Demographics
NPI:1427572254
Name:MARKIN, LISA CHRISTINE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:CHRISTINE
Last Name:MARKIN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:CHRISTINE
Other - Last Name:HEPTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:915 FERN LEAF DR
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-2001
Mailing Address - Country:US
Mailing Address - Phone:727-366-1158
Mailing Address - Fax:
Practice Address - Street 1:233 COURTYARD BLVD APT 107
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-5771
Practice Address - Country:US
Practice Address - Phone:813-633-5771
Practice Address - Fax:813-327-4735
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA9891224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant