Provider Demographics
NPI:1649467762
Name:ADDINGTON, LISA RENEE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:RENEE
Last Name:ADDINGTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:RENEE
Other - Last Name:WENZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:PO BOX 332
Mailing Address - Street 2:3307 ONEIDA STREET
Mailing Address - City:CHADWICKS
Mailing Address - State:NY
Mailing Address - Zip Code:13319-0332
Mailing Address - Country:US
Mailing Address - Phone:315-794-0520
Mailing Address - Fax:
Practice Address - Street 1:1550 EMPIRE BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2104
Practice Address - Country:US
Practice Address - Phone:585-922-2284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004153-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist