Provider Demographics
NPI:1871836452
Name:FOUNDAS, LISA MARIE (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:FOUNDAS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 GLEN LN
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-1304
Mailing Address - Country:US
Mailing Address - Phone:631-445-3871
Mailing Address - Fax:
Practice Address - Street 1:34 GLEN LN
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-1304
Practice Address - Country:US
Practice Address - Phone:631-445-3871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015902-1225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation