Provider Demographics
NPI:1477718203
Name:NELSON-HORN, LISETTE MARIE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LISETTE
Middle Name:MARIE
Last Name:NELSON-HORN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 AUGUSTINE CT
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7498
Mailing Address - Country:US
Mailing Address - Phone:407-359-9419
Mailing Address - Fax:
Practice Address - Street 1:310 AUGUSTINE CT
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7498
Practice Address - Country:US
Practice Address - Phone:407-359-9419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9608225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist