Provider Demographics
NPI:1558754382
Name:BERAN, LISA LEE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LEE
Last Name:BERAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45515 DRIVE 812
Mailing Address - Street 2:
Mailing Address - City:SARGENT
Mailing Address - State:NE
Mailing Address - Zip Code:68874-3140
Mailing Address - Country:US
Mailing Address - Phone:308-325-2388
Mailing Address - Fax:
Practice Address - Street 1:45255 ROAD 800
Practice Address - Street 2:
Practice Address - City:ANSLEY
Practice Address - State:NE
Practice Address - Zip Code:68814-5120
Practice Address - Country:US
Practice Address - Phone:308-750-9467
Practice Address - Fax:308-210-8810
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1844225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist