Provider Demographics
NPI:1396724506
Name:HOUSEL, LISA J (OTR/L)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:HOUSEL
Suffix:
Gender:F
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 1:6119 BROAD RIVER RUN
Mailing Address - Street 2:
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-7273
Mailing Address - Country:US
Mailing Address - Phone:941-729-5519
Mailing Address - Fax:
Practice Address - Street 1:3938 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-3622
Practice Address - Country:US
Practice Address - Phone:941-366-0011
Practice Address - Fax:941-957-0033
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 9186225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0242OtherRR MEDICARE
Z098DOtherBLUE CROSS BLUE SHIELD FL
Z098DOtherBLUE CROSS BLUE SHIELD FL