Provider Demographics
NPI:1770042673
Name:SLAMA, LISA MARIE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:SLAMA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:LUDLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2112 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-8034
Mailing Address - Country:US
Mailing Address - Phone:402-516-6707
Mailing Address - Fax:
Practice Address - Street 1:10730 PACIFIC ST STE 210
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4761
Practice Address - Country:US
Practice Address - Phone:402-753-7230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2166225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist