Provider Demographics
NPI:1528116902
Name:OWENS, LISA M (OTRL)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:OWENS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19007 61ST AVENUE NE #5
Mailing Address - Street 2:C O HPI
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-6300
Mailing Address - Country:US
Mailing Address - Phone:360-435-8989
Mailing Address - Fax:360-403-8347
Practice Address - Street 1:19007 61ST AVENUE NE #5
Practice Address - Street 2:C O HPI
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-6300
Practice Address - Country:US
Practice Address - Phone:360-435-8989
Practice Address - Fax:360-403-8347
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002568225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA197625OtherDEPT OF LABOR & INDUSTRIE