Provider Demographics
NPI:1629259155
Name:WELCH, LISA ANN (MOT, OT/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:WELCH
Suffix:
Gender:F
Credentials:MOT, OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 STEVENSON AVE APT 421
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-3588
Mailing Address - Country:US
Mailing Address - Phone:703-778-4980
Mailing Address - Fax:
Practice Address - Street 1:7777 LEESBURG PIKE
Practice Address - Street 2:#306S - MEDSTAR VNA
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-2411
Practice Address - Country:US
Practice Address - Phone:703-748-1533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004812225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist