Provider Demographics
NPI:1851865141
Name:AUBERT, LISA ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:AUBERT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3704 PEMBROOKE LN
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2325
Mailing Address - Country:US
Mailing Address - Phone:708-310-9576
Mailing Address - Fax:
Practice Address - Street 1:18 BROAD STREET
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NEW YORK
Practice Address - Zip Code:13790
Practice Address - Country:UM
Practice Address - Phone:607-798-7117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-19
Last Update Date:2019-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022746-1225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist