Provider Demographics
NPI:1215133475
Name:LITTERER, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LITTERER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2038 CHEYENNE AVE
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:IA
Mailing Address - Zip Code:50645-9491
Mailing Address - Country:US
Mailing Address - Phone:319-404-7830
Mailing Address - Fax:
Practice Address - Street 1:2038 CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:IA
Practice Address - Zip Code:50645-9491
Practice Address - Country:US
Practice Address - Phone:319-404-7830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist