Provider Demographics
NPI:1851941462
Name:HOATLIN, LISA SUE (OTR)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:SUE
Last Name:HOATLIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7960 ALTA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:PINCKNEY
Mailing Address - State:MI
Mailing Address - Zip Code:48169-8476
Mailing Address - Country:US
Mailing Address - Phone:734-260-1608
Mailing Address - Fax:
Practice Address - Street 1:26750 PROVIDENCE PKWY
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1211
Practice Address - Country:US
Practice Address - Phone:734-260-1608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003033225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist