Provider Demographics
NPI:1811154982
Name:BREWER, LISA SUZANNE (MOTR)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:SUZANNE
Last Name:BREWER
Suffix:
Gender:F
Credentials:MOTR
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:IONADI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3201 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6445
Mailing Address - Country:US
Mailing Address - Phone:989-486-1128
Mailing Address - Fax:
Practice Address - Street 1:449 QUARTER ST
Practice Address - Street 2:
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624-1918
Practice Address - Country:US
Practice Address - Phone:989-426-3430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist