Provider Demographics
NPI:1699826925
Name:STEVENS, LISA M (OTR)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:STEVENS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 DESERT MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-7624
Mailing Address - Country:US
Mailing Address - Phone:775-626-3442
Mailing Address - Fax:
Practice Address - Street 1:10587 DOUBLE R BLVD
Practice Address - Street 2:101
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-8909
Practice Address - Country:US
Practice Address - Phone:775-324-5371
Practice Address - Fax:775-852-5373
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0097225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics