Provider Demographics
NPI:1851417992
Name:SPIEGEL, LISA P (COTA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:P
Last Name:SPIEGEL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:PHYLLIS
Other - Middle Name:LISA
Other - Last Name:SPIEGEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:3311 GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-2130
Mailing Address - Country:US
Mailing Address - Phone:323-662-7476
Mailing Address - Fax:
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:OCCUPATIONAL THERAPY DEPT MS56 CHLA
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-669-2118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1256224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant