Provider Demographics
NPI:1861465882
Name:DREISKE, LISA M (OTR/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:DREISKE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:LEMMON
Mailing Address - State:SD
Mailing Address - Zip Code:57638-1834
Mailing Address - Country:US
Mailing Address - Phone:605-374-5844
Mailing Address - Fax:605-374-9524
Practice Address - Street 1:601 MAIN AVE
Practice Address - Street 2:
Practice Address - City:LEMMON
Practice Address - State:SD
Practice Address - Zip Code:57638-1834
Practice Address - Country:US
Practice Address - Phone:605-374-5844
Practice Address - Fax:605-374-9524
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0543225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5833250Medicaid
SD9192188OtherDAKOTACARE
ND52624OtherND MEDICAID
SD4996665OtherWELLMARK BCBS
SD4996665OtherWELLMARK BCBS