Provider Demographics
NPI:1578522983
Name:WEINGARTZ, LISA B (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:B
Last Name:WEINGARTZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20554 HALL RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5326
Mailing Address - Country:US
Mailing Address - Phone:586-598-1247
Mailing Address - Fax:586-598-1260
Practice Address - Street 1:20554 HALL RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-5326
Practice Address - Country:US
Practice Address - Phone:586-598-1247
Practice Address - Fax:586-598-1260
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000119225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist