Provider Demographics
NPI:1487972998
Name:WHITE, LISA NICOLE (OTR/L)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:NICOLE
Last Name:WHITE
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 1:13316 HUMBOLDT DR
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-1195
Mailing Address - Country:US
Mailing Address - Phone:858-232-9937
Mailing Address - Fax:
Practice Address - Street 1:13316 HUMBOLDT DR
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-1195
Practice Address - Country:US
Practice Address - Phone:858-232-9937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT2406225X00000X
COOT2922225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist