Provider Demographics
NPI:1356432942
Name:D'ANDRADE, LISA ANN (OTR/L, CHT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:D'ANDRADE
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19000 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1517
Mailing Address - Country:US
Mailing Address - Phone:310-371-5111
Mailing Address - Fax:310-371-8528
Practice Address - Street 1:16020 PARK VALLEY DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3573
Practice Address - Country:US
Practice Address - Phone:512-388-1448
Practice Address - Fax:512-388-7854
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1864225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
20-8488154OtherEMPLOYER IDENTIFICATION #
CAN989652Medicare ID - Type Unspecified