Provider Demographics
NPI:1528209822
Name:MASSEY, LISA MICHELLE (MOT, OTR, CLT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MICHELLE
Last Name:MASSEY
Suffix:
Gender:F
Credentials:MOT, OTR, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W CRAIG PL
Mailing Address - Street 2:UNIT E
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3470
Mailing Address - Country:US
Mailing Address - Phone:210-833-5188
Mailing Address - Fax:
Practice Address - Street 1:201 W CRAIG PL
Practice Address - Street 2:UNIT E
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3470
Practice Address - Country:US
Practice Address - Phone:210-833-5188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111105225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist