Provider Demographics
NPI:1427472323
Name:HARASIMCHUK, LISA (COTA/L)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HARASIMCHUK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2476 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-5442
Mailing Address - Country:US
Mailing Address - Phone:440-554-7479
Mailing Address - Fax:
Practice Address - Street 1:175 AVON BELDEN RD
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-1600
Practice Address - Country:US
Practice Address - Phone:440-933-4829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA 02972224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant