Provider Demographics
NPI:1457665861
Name:HELD, LISA ANNE (OTR/CCM)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:HELD
Suffix:
Gender:F
Credentials:OTR/CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:920-459-1460
Practice Address - Street 1:1001 SERVICE RD
Practice Address - Street 2:
Practice Address - City:KIEL
Practice Address - State:WI
Practice Address - Zip Code:53042-1297
Practice Address - Country:US
Practice Address - Phone:920-894-2636
Practice Address - Fax:920-894-1005
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2122-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100011164Medicaid