Provider Demographics
NPI:1679834352
Name:GEORGE, LISA ANNE (OTR)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANNE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3090 N ACADEMY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5310
Mailing Address - Country:US
Mailing Address - Phone:719-574-8300
Mailing Address - Fax:719-574-9547
Practice Address - Street 1:3090 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5310
Practice Address - Country:US
Practice Address - Phone:719-574-8300
Practice Address - Fax:719-574-9547
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2130225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO975189OtherNBC OT
CO0397622OtherSTATE OF COLORADO-CDE
CO2130OtherCOLORADO CERTIFICATION