Provider Demographics
NPI:1568662138
Name:GILLESPIE, LISA E (OTR/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:E
Last Name:GILLESPIE
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:PO BOX 11605
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87192-0605
Mailing Address - Country:US
Mailing Address - Phone:505-298-6440
Mailing Address - Fax:505-298-7502
Practice Address - Street 1:12306 MENAUL BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1781
Practice Address - Country:US
Practice Address - Phone:505-298-6440
Practice Address - Fax:505-298-7502
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM158225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist