Provider Demographics
NPI:1841547676
Name:KIRKPATRICK, LISA RENEE (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:RENEE
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:MS, OTR/L
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:1079 BROOKS RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30747-5517
Mailing Address - Country:US
Mailing Address - Phone:706-895-2601
Mailing Address - Fax:
Practice Address - Street 1:1079 BROOKS RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30747-5517
Practice Address - Country:US
Practice Address - Phone:706-895-2601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT04118225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist