Provider Demographics
NPI:1689868051
Name:SPELLMAN, LISA ANN (MOTR/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:SPELLMAN
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 SETTER PL
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-3238
Mailing Address - Country:US
Mailing Address - Phone:412-831-2494
Mailing Address - Fax:
Practice Address - Street 1:1200 BRAUN RD
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-3106
Practice Address - Country:US
Practice Address - Phone:412-854-5500
Practice Address - Fax:412-854-4742
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010451225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist