Provider Demographics
NPI:1750638151
Name:HEMANN, LISA ANN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:HEMANN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:BERLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:4121 PENNYSLVANIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2268
Mailing Address - Country:US
Mailing Address - Phone:563-583-4003
Mailing Address - Fax:563-583-4737
Practice Address - Street 1:4121 PENNYSLVANIA AVENUE
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-2268
Practice Address - Country:US
Practice Address - Phone:563-583-4003
Practice Address - Fax:563-583-4737
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002194225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0665950Medicaid
IA0665950Medicaid