Provider Demographics
NPI:1639418700
Name:VINSON, LISA J (COTA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:VINSON
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:PO BOX 4249
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33509-4249
Mailing Address - Country:US
Mailing Address - Phone:813-310-2105
Mailing Address - Fax:813-703-6280
Practice Address - Street 1:2780 E FOWLER AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-6297
Practice Address - Country:US
Practice Address - Phone:813-310-2105
Practice Address - Fax:813-703-6280
Is Sole Proprietor?:No
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA6981224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant