Provider Demographics
NPI:1720144041
Name:MARQUIS, LISA
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:MARQUIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:MARQUIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 WILLIAMS WAY
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NH
Mailing Address - Zip Code:03049-5958
Mailing Address - Country:US
Mailing Address - Phone:603-889-2132
Mailing Address - Fax:603-889-3240
Practice Address - Street 1:10 WILLIAMS WAY
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NH
Practice Address - Zip Code:03049-5958
Practice Address - Country:US
Practice Address - Phone:603-889-2132
Practice Address - Fax:603-889-3240
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1961225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist