Provider Demographics
NPI:1669727780
Name:COSTA, LISA ANN (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:COSTA
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 FEARRINGTON POST
Mailing Address - Street 2:44 CASWELL
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312
Mailing Address - Country:US
Mailing Address - Phone:801-680-0869
Mailing Address - Fax:702-804-2551
Practice Address - Street 1:1807 FORDHAM BLVD. UNC HEALTH CRC
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514
Practice Address - Country:US
Practice Address - Phone:984-974-9700
Practice Address - Fax:702-804-2551
Is Sole Proprietor?:No
Enumeration Date:2012-07-14
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14628225X00000X
NV12-0240225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist