Provider Demographics
NPI:1659665479
Name:DIMEO, LISA (OT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:DIMEO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 BERLIN RD
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-1019
Mailing Address - Country:US
Mailing Address - Phone:860-635-1010
Mailing Address - Fax:860-635-2571
Practice Address - Street 1:156 BERLIN RD
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-1019
Practice Address - Country:US
Practice Address - Phone:860-635-1010
Practice Address - Fax:860-635-2571
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002659225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist