Provider Demographics
NPI:1518175629
Name:WILSON, LISA DAWN (OTR)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:DAWN
Last Name:WILSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5667 W 115TH CT
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80020-6846
Mailing Address - Country:US
Mailing Address - Phone:303-466-1256
Mailing Address - Fax:
Practice Address - Street 1:550 THORNTON PKWY UNIT 110
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2166
Practice Address - Country:US
Practice Address - Phone:303-341-1799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist