Provider Demographics
NPI:1063793693
Name:HALSTEAD, LISA ANN (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:HALSTEAD
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NY
Mailing Address - Zip Code:14569-1530
Mailing Address - Country:US
Mailing Address - Phone:585-689-0654
Mailing Address - Fax:
Practice Address - Street 1:43 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1530
Practice Address - Country:US
Practice Address - Phone:585-689-0654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016901-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics