Provider Demographics
NPI:1740568898
Name:ROSS, LISA (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 PACIFIC AVE
Mailing Address - Street 2:PO BOX 1067
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4168
Mailing Address - Country:US
Mailing Address - Phone:425-258-7310
Mailing Address - Fax:425-258-7618
Practice Address - Street 1:900 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4168
Practice Address - Country:US
Practice Address - Phone:425-258-7310
Practice Address - Fax:425-258-7618
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00004488225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics