Provider Demographics
NPI:1306120613
Name:CRISALLI, LISA (OT/L, ATP, CDRS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CRISALLI
Suffix:
Gender:F
Credentials:OT/L, ATP, CDRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2056 NW 100TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-4012
Mailing Address - Country:US
Mailing Address - Phone:352-278-8087
Mailing Address - Fax:
Practice Address - Street 1:2056 NW 100TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-4012
Practice Address - Country:US
Practice Address - Phone:352-278-8087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 1945225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist