Provider Demographics
NPI:1548574510
Name:HART, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CROCKER AVE N
Mailing Address - Street 2:
Mailing Address - City:WHITEFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04353-3928
Mailing Address - Country:US
Mailing Address - Phone:207-549-5634
Mailing Address - Fax:
Practice Address - Street 1:8 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04937-1325
Practice Address - Country:US
Practice Address - Phone:207-453-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist