Provider Demographics
NPI:1841565306
Name:GEERTSEN, LISBETH SUSANNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:LISBETH
Middle Name:SUSANNE
Last Name:GEERTSEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LISBETH
Other - Middle Name:SUSANNE
Other - Last Name:ANDERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29855 VISTA DEL ARROYO
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-3037
Mailing Address - Country:US
Mailing Address - Phone:650-452-2711
Mailing Address - Fax:
Practice Address - Street 1:29855 VISTA DEL ARROYO
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-3037
Practice Address - Country:US
Practice Address - Phone:650-452-2711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-16
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20923OtherSTATE LICENSE