Provider Demographics
NPI:1639685225
Name:CROTTS, LISA ELLEDGE (OTR/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ELLEDGE
Last Name:CROTTS
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 1:265 CEDAR PT
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-4242
Mailing Address - Country:US
Mailing Address - Phone:276-733-4391
Mailing Address - Fax:
Practice Address - Street 1:202 PAINTER ST
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-3830
Practice Address - Country:US
Practice Address - Phone:276-236-5164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist