Provider Demographics
NPI:1740233261
Name:COHEN, LISA B (OTR/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:B
Last Name:COHEN
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 1:55 MONROE BLVD APT 6E
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4365
Mailing Address - Country:US
Mailing Address - Phone:516-659-2580
Mailing Address - Fax:
Practice Address - Street 1:55 MONROE BLVD APT 6E
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4365
Practice Address - Country:US
Practice Address - Phone:516-659-2580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012746-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist