Provider Demographics
NPI:1154601029
Name:MESECAR, LISA ELLEN (OTR/L)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ELLEN
Last Name:MESECAR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11030 RAVEN RIDGE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8511
Mailing Address - Country:US
Mailing Address - Phone:919-844-6611
Mailing Address - Fax:919-844-6612
Practice Address - Street 1:11030 RAVEN RIDGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8511
Practice Address - Country:US
Practice Address - Phone:919-844-6611
Practice Address - Fax:919-844-6612
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7954225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist