MEDICARE: MS. LISA ANN BRANSCUM OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	31002976A	IN
2	225X00000X	Occupational Therapist	OT26593	FL

General Provider Information

NPI Number	:	1598831711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA ANN BRANSCUM OTR

Provider Business Mailing Address
First Line	:	1499 6TH ST NW
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-2365
Country	:	US
Telephone Number	:	863-293-7778
Fax Number	:	863-299-3836

Provider Business Practice Location Address
First Line	:	1499 6TH ST NW
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-2365
Country	:	US
Telephone Number	:	863-293-7778
Fax Number	:	863-299-3836

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	12/03/2025

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