Provider Demographics
NPI:1679845796
Name:CLEVELAND, LISA MARIE (OTD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30417 N 42ND PL
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-3860
Mailing Address - Country:US
Mailing Address - Phone:480-650-6020
Mailing Address - Fax:
Practice Address - Street 1:17462 N 94TH ST
Practice Address - Street 2:1099
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-6501
Practice Address - Country:US
Practice Address - Phone:480-650-6020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-05
Last Update Date:2012-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4388225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist