Provider Demographics
NPI:1619042355
Name:LISI, LEZLEE COLETTE (OTR/L, MOT)
Entity Type:Individual
Prefix:
First Name:LEZLEE
Middle Name:COLETTE
Last Name:LISI
Suffix:
Gender:F
Credentials:OTR/L, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 STOCKER DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7415
Mailing Address - Country:US
Mailing Address - Phone:304-685-1066
Mailing Address - Fax:
Practice Address - Street 1:19 STOCKER DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7415
Practice Address - Country:US
Practice Address - Phone:843-302-6393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
SC3370225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty