Provider Demographics
NPI:1154768505
Name:YOUNG, LISA KAY (OTR)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KAY
Last Name:YOUNG
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:KAY
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:307 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:WI
Mailing Address - Zip Code:54961-1410
Mailing Address - Country:US
Mailing Address - Phone:715-421-8836
Mailing Address - Fax:
Practice Address - Street 1:5412 US HIGHWAY 10 E
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54482-8559
Practice Address - Country:US
Practice Address - Phone:715-346-5243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2207-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist