Provider Demographics
NPI:1871994509
Name:BATTENHAUSEN, LISA (COTA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BATTENHAUSEN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SOUTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3887
Mailing Address - Country:US
Mailing Address - Phone:518-280-4294
Mailing Address - Fax:518-280-4297
Practice Address - Street 1:7 SOUTHSIDE DR
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3887
Practice Address - Country:US
Practice Address - Phone:518-280-4294
Practice Address - Fax:518-280-4297
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008539-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant