Provider Demographics
NPI:1215113899
Name:GENTILINI, LISA MARIE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:GENTILINI
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 1:10710 MIDLOTHIAN TPKE
Mailing Address - Street 2:FAIRFAX BUILDING SUITE 127
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4722
Mailing Address - Country:US
Mailing Address - Phone:804-267-6726
Mailing Address - Fax:804-267-6759
Practice Address - Street 1:10710 MIDLOTHIAN TPKE
Practice Address - Street 2:FAIRFAX BUILDING SUITE 127
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4722
Practice Address - Country:US
Practice Address - Phone:804-267-6726
Practice Address - Fax:804-267-6759
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003675225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist