Healthcare Provider Details

I. General information

NPI: 1336350602
Provider Name (Legal Business Name): LISA E TOWERY OTR-L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6373 AUTUMN BERRY CIR
JACKSONVILLE FL
32258-8416
US

IV. Provider business mailing address

6373 AUTUMN BERRY CIR
JACKSONVILLE FL
32258-8416
US

V. Phone/Fax

Practice location:
  • Phone: 49-079-4629
  • Fax:
Mailing address:
  • Phone: 904-907-9462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT14693
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 14693
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: