Provider Demographics
NPI:1881852135
Name:STANGLER, LISA MARIE (OTR)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:STANGLER
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 1:626 E SLIFER ST
Mailing Address - Street 2:PO BOX 564
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-1224
Mailing Address - Country:US
Mailing Address - Phone:608-742-8814
Mailing Address - Fax:
Practice Address - Street 1:626 E SLIFER ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-1224
Practice Address - Country:US
Practice Address - Phone:608-742-8814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1352 026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40898300Medicaid