Provider Demographics
NPI:1245451830
Name:CROSS, LISA J (COTA)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:J
Last Name:CROSS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 CITY PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701
Mailing Address - Country:US
Mailing Address - Phone:757-650-0460
Mailing Address - Fax:757-668-6246
Practice Address - Street 1:11783 ROCK LANDING DR.
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606
Practice Address - Country:US
Practice Address - Phone:757-668-6244
Practice Address - Fax:757-668-6246
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant