Provider Demographics
NPI:1447539366
Name:WASHINGTON, LISA ANN (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 WILLOWLEAF WAY
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277
Mailing Address - Country:US
Mailing Address - Phone:770-463-4192
Mailing Address - Fax:
Practice Address - Street 1:233 WILLOWLEAF WAY
Practice Address - Street 2:
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-4685
Practice Address - Country:US
Practice Address - Phone:770-463-4192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000551224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant