Provider Demographics
NPI:1528216561
Name:WISTER, LISA H (OT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:H
Last Name:WISTER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:H
Other - Last Name:KATZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:923 S HUMPHREY AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1720
Mailing Address - Country:US
Mailing Address - Phone:773-230-3365
Mailing Address - Fax:708-383-2713
Practice Address - Street 1:923 S HUMPHREY AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1720
Practice Address - Country:US
Practice Address - Phone:773-230-3365
Practice Address - Fax:708-383-2713
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007137225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist