Provider Demographics
NPI:1740299270
Name:CONDON, LISA MARIE (OTR, CHT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:CONDON
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:FITZGERALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR, CHT
Mailing Address - Street 1:660 GOLDEN RIDGE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401
Mailing Address - Country:US
Mailing Address - Phone:720-497-6616
Mailing Address - Fax:720-497-6767
Practice Address - Street 1:660 GOLDEN RIDGE RD
Practice Address - Street 2:STE 200
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-9541
Practice Address - Country:US
Practice Address - Phone:720-497-6616
Practice Address - Fax:720-497-6767
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
970694225X00000X
9511000148225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
102255327OtherOWCP FACILITY PROVIDER ID
CO066579Medicare Oscar/Certification