Provider Demographics
NPI:1598172850
Name:HAAS, LISA LYNN (COTA)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:LYNN
Last Name:HAAS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3753 HARLAN
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-7427
Mailing Address - Country:US
Mailing Address - Phone:303-898-7921
Mailing Address - Fax:
Practice Address - Street 1:3753 HARLAN ST
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-7427
Practice Address - Country:US
Practice Address - Phone:303-898-7921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000508224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant