Provider Demographics
NPI:1497713119
Name:LITCHFORD, LISA MARIE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:LITCHFORD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:130 INTEGRA VILLAGE TRL
Mailing Address - Street 2:APT 340
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-9322
Mailing Address - Country:US
Mailing Address - Phone:904-728-7402
Mailing Address - Fax:407-857-9566
Practice Address - Street 1:14055 TOWN LOOP BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6105
Practice Address - Country:US
Practice Address - Phone:407-857-6285
Practice Address - Fax:407-857-9566
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015420000Medicaid
AR156500721Medicaid