Provider Demographics
NPI:1255618583
Name:MAXWELL, LISA JANE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JANE
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:JANE
Other - Last Name:MULLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:GALLITZIN
Mailing Address - State:PA
Mailing Address - Zip Code:16641-0028
Mailing Address - Country:US
Mailing Address - Phone:618-973-4388
Mailing Address - Fax:
Practice Address - Street 1:807 GOUCHER ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-2942
Practice Address - Country:US
Practice Address - Phone:814-255-4921
Practice Address - Fax:814-255-4921
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011896225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396822Medicare Oscar/Certification