Provider Demographics
NPI:1831261759
Name:SANDOVAL, LISA ANN (OT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10293 BENTWOOD LANE
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126
Mailing Address - Country:US
Mailing Address - Phone:303-850-7247
Mailing Address - Fax:720-493-5499
Practice Address - Street 1:10717 JORDAN CT
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134
Practice Address - Country:US
Practice Address - Phone:303-840-6494
Practice Address - Fax:303-805-0602
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C521448Medicare ID - Type Unspecified