Provider Demographics
NPI:1639503360
Name:MINTER, LISA ANNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:MINTER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:IN
Mailing Address - Zip Code:46506-1644
Mailing Address - Country:US
Mailing Address - Phone:574-302-6349
Mailing Address - Fax:
Practice Address - Street 1:6330 N FIR RD
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-4753
Practice Address - Country:US
Practice Address - Phone:574-247-4071
Practice Address - Fax:574-204-2192
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002258A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist