Provider Demographics
NPI:1881893261
Name:WISHART, LUSANN M (COTA)
Entity type:Individual
Prefix:
First Name:LUSANN
Middle Name:M
Last Name:WISHART
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:LUSANN
Other - Middle Name:M
Other - Last Name:NICHOLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:59 SHEFFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-2314
Mailing Address - Country:US
Mailing Address - Phone:603-622-0909
Mailing Address - Fax:603-622-2869
Practice Address - Street 1:59 SHEFFIELD RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-2314
Practice Address - Country:US
Practice Address - Phone:603-622-0909
Practice Address - Fax:603-622-2869
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1179224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant