Provider Demographics
NPI:1013572759
Name:PALMISANO, LISA ANN (OT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:PALMISANO
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 1:1902 ORANGE TREE LN STE 100
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2800
Mailing Address - Country:US
Mailing Address - Phone:909-500-1191
Mailing Address - Fax:909-494-7870
Practice Address - Street 1:1902 ORANGE TREE LN STE 100
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2800
Practice Address - Country:US
Practice Address - Phone:909-500-1191
Practice Address - Fax:909-494-7870
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist