Provider Demographics
NPI:1851636864
Name:GRIFFIN, LISA ANN (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 DEERLAKE DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3600
Mailing Address - Country:US
Mailing Address - Phone:404-374-5126
Mailing Address - Fax:
Practice Address - Street 1:11350 WOODSTOCK RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-7541
Practice Address - Country:US
Practice Address - Phone:404-374-5126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-02
Last Update Date:2012-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA1126680224ZL0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantLow Vision