Provider Demographics
NPI:1952518276
Name:WARREN, LISA M (COTAL)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:WARREN
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1359 NIAGARA AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-2717
Mailing Address - Country:US
Mailing Address - Phone:330-733-7767
Mailing Address - Fax:
Practice Address - Street 1:4511 ROCKSIDE RD STE 130
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2199
Practice Address - Country:US
Practice Address - Phone:216-901-0400
Practice Address - Fax:216-901-0401
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA1212224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant