Provider Demographics
NPI:1801924535
Name:SESTITO, LISA M
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:SESTITO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ROGLER FARM RD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-1218
Mailing Address - Country:US
Mailing Address - Phone:401-231-5207
Mailing Address - Fax:
Practice Address - Street 1:283 COUNTY RD
Practice Address - Street 2:SPECIAL EDUCATION DEPARTMENT
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-2406
Practice Address - Country:US
Practice Address - Phone:401-247-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT00335225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist