Provider Demographics
NPI:1790894012
Name:SMITH, LISA A (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L, CHT
Mailing Address - Street 1:4200 DAHLBERG DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4840
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:952-512-5651
Practice Address - Street 1:8540 QUADAY AVE NE
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-6522
Practice Address - Country:US
Practice Address - Phone:763-441-0298
Practice Address - Fax:763-441-0591
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102714225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand