Provider Demographics
NPI:1265561914
Name:FOX, LISA R (OTR)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:R
Last Name:FOX
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 1:7 HILLSIDE TER
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-2104
Mailing Address - Country:US
Mailing Address - Phone:845-354-5829
Mailing Address - Fax:
Practice Address - Street 1:7 HILLSIDE TER
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-2104
Practice Address - Country:US
Practice Address - Phone:845-354-5829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009157-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist