Provider Demographics
NPI:1104975267
Name:AIKINS, LISA (OTR, CHT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:AIKINS
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:SHAREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR CHT
Mailing Address - Street 1:805 E WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-7027
Mailing Address - Country:US
Mailing Address - Phone:058-735-3714
Mailing Address - Fax:805-736-6392
Practice Address - Street 1:805 E WALNUT AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7027
Practice Address - Country:US
Practice Address - Phone:805-735-3714
Practice Address - Fax:805-736-6392
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT348225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ554152Medicare ID - Type Unspecified