Healthcare Provider Details

I. General information

NPI: 1033418967
Provider Name (Legal Business Name): LISA JEAN FERCH OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA JEAN RAUSCHENBERGER OTR/L

II. Dates (important events)

Enumeration Date: 03/17/2011
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6340 VARIEL AVE STE A
WOODLAND HILLS CA
91367
US

IV. Provider business mailing address

6340 VARIEL AVE STE A
WOODLAND HILLS CA
91367
US

V. Phone/Fax

Practice location:
  • Phone: 818-888-4559
  • Fax: 818-888-4005
Mailing address:
  • Phone: 818-888-4559
  • Fax: 818-888-4005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number11736
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: