Provider Demographics
NPI:1871232215
Name:OKOCHI, LISA
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:OKOCHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2843 E 195TH ST APT 1R
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3965
Mailing Address - Country:US
Mailing Address - Phone:917-940-8271
Mailing Address - Fax:
Practice Address - Street 1:2843 E 195TH ST APT 1R
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3965
Practice Address - Country:US
Practice Address - Phone:917-940-8271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019543-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist