Provider Demographics
NPI:1104279702
Name:VIANA, LISA BETH (OT/L)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:BETH
Last Name:VIANA
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:BETH
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT/L
Mailing Address - Street 1:155 NEVIS WAY
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8594
Mailing Address - Country:US
Mailing Address - Phone:336-601-4727
Mailing Address - Fax:
Practice Address - Street 1:155 NEVIS WAY
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8594
Practice Address - Country:US
Practice Address - Phone:336-601-4727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9557225X00000X, 225XP0200X
225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG76041Medicaid
NCG76041Medicaid