Provider Demographics
NPI:1336205772
Name:TAORMINA, LISA SHINDORE (MOT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:SHINDORE
Last Name:TAORMINA
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:TAORMINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MOT
Mailing Address - Street 1:1333 S OCEAN BLVD APT 714
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-6933
Mailing Address - Country:US
Mailing Address - Phone:561-715-6242
Mailing Address - Fax:
Practice Address - Street 1:1333 S OCEAN BLVD APT 714
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-6933
Practice Address - Country:US
Practice Address - Phone:561-715-6242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11014222Q00000X, 252Y00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017010100Medicaid