Provider Demographics
NPI:1770719809
Name:ROLAND, LISA D (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:D
Last Name:ROLAND
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:PO BOX 7635
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-7635
Mailing Address - Country:US
Mailing Address - Phone:847-816-7200
Mailing Address - Fax:847-816-7210
Practice Address - Street 1:250 CENTER DR
Practice Address - Street 2:SUITE 101-A
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1582
Practice Address - Country:US
Practice Address - Phone:847-816-7200
Practice Address - Fax:847-816-7210
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.007394225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist