Provider Demographics
NPI:1073638169
Name:MAGGIORE, LISA (OTR, L CHT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:MAGGIORE
Suffix:
Gender:F
Credentials:OTR, L CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 POST RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4622
Mailing Address - Country:US
Mailing Address - Phone:203-422-0679
Mailing Address - Fax:
Practice Address - Street 1:333 POST RD W
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4754
Practice Address - Country:US
Practice Address - Phone:203-422-0679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000176225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT670000085Medicare ID - Type UnspecifiedC02816