Provider Demographics
NPI:1114130754
Name:HERRMANN, LISA LYN (MS OTR L)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LYN
Last Name:HERRMANN
Suffix:
Gender:F
Credentials:MS OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1941 E WESCOTT DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-2434
Mailing Address - Country:US
Mailing Address - Phone:602-441-5975
Mailing Address - Fax:602-485-8859
Practice Address - Street 1:15116 N COTTON LN
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-9618
Practice Address - Country:US
Practice Address - Phone:623-322-8250
Practice Address - Fax:602-325-8206
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Z00000X, 224ZF0002X, 2251P0200X, 225200000X, 225XF0002X, 225XP0200X, 2355S0801X, 235Z00000X, 225X00000X
AZ2762225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No224ZF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantFeeding, Eating & Swallowing
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist