Provider Demographics
NPI:1831383249
Name:SLUPEK, LISA J (COTA/L)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:J
Last Name:SLUPEK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 FORRESTDALE RD
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17228-9322
Mailing Address - Country:US
Mailing Address - Phone:724-448-1317
Mailing Address - Fax:
Practice Address - Street 1:100 LITTLE DR
Practice Address - Street 2:
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-3345
Practice Address - Country:US
Practice Address - Phone:724-339-1071
Practice Address - Fax:724-339-2882
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Z00000X
PAOPOO3294L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1831383249Medicaid