Provider Demographics
NPI:1811434640
Name:SERBY, LISA B (OTR/L)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:B
Last Name:SERBY
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 1:224 ENTRANCE RD
Mailing Address - Street 2:UNIT 2
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-2777
Mailing Address - Country:US
Mailing Address - Phone:805-450-5805
Mailing Address - Fax:
Practice Address - Street 1:1900 STATE ST
Practice Address - Street 2:SUITE K
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2429
Practice Address - Country:US
Practice Address - Phone:805-450-5805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 6341225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1027009OtherNBCOT
CAOT 6341OtherCBOT