Provider Demographics
NPI:1992988570
Name:BLISS, LISA ANN (COTA/L)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:BLISS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:FETTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:25412 S COLUMBIA BASIN HWY
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-7962
Mailing Address - Country:US
Mailing Address - Phone:509-239-4579
Mailing Address - Fax:
Practice Address - Street 1:506 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:RITZVILLE
Practice Address - State:WA
Practice Address - Zip Code:99169-2106
Practice Address - Country:US
Practice Address - Phone:509-659-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC0000213224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant