Provider Demographics
NPI:1568784080
Name:BARTON, LISA RENEE (OTR/L CAPS)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:RENEE
Last Name:BARTON
Suffix:
Gender:F
Credentials:OTR/L CAPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5705 SOUTHDOWN LN
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-6910
Mailing Address - Country:US
Mailing Address - Phone:815-988-5526
Mailing Address - Fax:
Practice Address - Street 1:6070 DOROTHY LN
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-9239
Practice Address - Country:US
Practice Address - Phone:815-988-5526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007815225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist