Provider Demographics
NPI:1740446244
Name:AZAR, LISA LEE (COTA)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LEE
Last Name:AZAR
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 TAAGA PL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-1835
Mailing Address - Country:US
Mailing Address - Phone:941-371-6186
Mailing Address - Fax:
Practice Address - Street 1:2415 UNIVERSITY PKWY
Practice Address - Street 2:SUITE 218, BLDG. 2
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2809
Practice Address - Country:US
Practice Address - Phone:941-359-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 10334224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant