Provider Demographics
NPI:1194273367
Name:ADAMS, LISA (LMT, COTA/L)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LMT, COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 S 262ND PL
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198
Mailing Address - Country:US
Mailing Address - Phone:253-230-7028
Mailing Address - Fax:
Practice Address - Street 1:933 S 262ND PL
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198
Practice Address - Country:US
Practice Address - Phone:253-230-7028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC60602513224Z00000X
WAMA60824013225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant