Provider Demographics
NPI:1013102862
Name:LIVESON, LISSA LOPE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LISSA
Middle Name:LOPE
Last Name:LIVESON
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 1:2100 CORPUS CHRISTI ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-3398
Mailing Address - Country:US
Mailing Address - Phone:956-724-5448
Mailing Address - Fax:956-724-5449
Practice Address - Street 1:2100 CORPUS CHRISTI ST
Practice Address - Street 2:SUITE 14
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-3398
Practice Address - Country:US
Practice Address - Phone:956-724-5448
Practice Address - Fax:956-724-5449
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111552225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist