Provider Demographics
NPI:1669077178
Name:NELSON, LISA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:NELSON
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 1:1157 VIEWMOOR CT
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-7642
Mailing Address - Country:US
Mailing Address - Phone:425-367-1387
Mailing Address - Fax:
Practice Address - Street 1:1157 VIEWMOOR CT
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-7642
Practice Address - Country:US
Practice Address - Phone:425-367-1387
Practice Address - Fax:509-385-0033
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT61593677225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist