Provider Demographics
NPI:1700149242
Name:HOLTMEYER, LISA KAREN (OTR/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:KAREN
Last Name:HOLTMEYER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:KAREN
Other - Last Name:LHAMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:31715 CEDAR TRL
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-4534
Mailing Address - Country:US
Mailing Address - Phone:636-359-5206
Mailing Address - Fax:
Practice Address - Street 1:31715 CEDAR TRL
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-4534
Practice Address - Country:US
Practice Address - Phone:636-359-5206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000424225XE0001X, 225XF0002X, 225XG0600X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation