Provider Demographics
NPI:1962573071
Name:FILLION, LISA L
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:L
Last Name:FILLION
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:L
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7160 WINDOVER WAY
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-7524
Mailing Address - Country:US
Mailing Address - Phone:321-385-3794
Mailing Address - Fax:321-385-3794
Practice Address - Street 1:7160 WINDOVER WAY
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-7524
Practice Address - Country:US
Practice Address - Phone:321-385-3794
Practice Address - Fax:321-385-3794
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT0001681225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist