Provider Demographics
NPI:1912365180
Name:DING, LISA KIM (OT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:KIM
Last Name:DING
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 PERSHING HWY
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71251-2046
Mailing Address - Country:US
Mailing Address - Phone:318-259-9899
Mailing Address - Fax:
Practice Address - Street 1:900 PERSHING HWY
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:LA
Practice Address - Zip Code:71251-2046
Practice Address - Country:US
Practice Address - Phone:318-259-9899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z11710225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAOTT.Z11710OtherLOUISIANA STATE MEDICAL SOCIETY