Provider Demographics
NPI:1336350602
Name:TOWERY, LISA E (OTR-L)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:E
Last Name:TOWERY
Suffix:
Gender:
Credentials:OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6373 AUTUMN BERRY CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-8416
Mailing Address - Country:US
Mailing Address - Phone:904-907-9462
Mailing Address - Fax:
Practice Address - Street 1:6373 AUTUMN BERRY CIR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-8416
Practice Address - Country:US
Practice Address - Phone:049-079-4629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT14693225X00000X
FLOT 14693225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist