Provider Demographics
NPI:1700935111
Name:WARREN, LISA RENAE (OTRL)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:RENAE
Last Name:WARREN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16902 HARRIERRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-5826
Mailing Address - Country:US
Mailing Address - Phone:813-431-9765
Mailing Address - Fax:
Practice Address - Street 1:16902 HARRIERRIDGE PL
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-5826
Practice Address - Country:US
Practice Address - Phone:813-431-9765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10419225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2008EOtherBCBS