Provider Demographics
NPI:1720213424
Name:RAYMOND-TOLAN, LISA MICHELE (OTR/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELE
Last Name:RAYMOND-TOLAN
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 1:362 15TH ST
Mailing Address - Street 2:APT 1R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5680
Mailing Address - Country:US
Mailing Address - Phone:646-932-1989
Mailing Address - Fax:
Practice Address - Street 1:532 COURT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-3986
Practice Address - Country:US
Practice Address - Phone:718-254-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014994-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics