Healthcare Provider Details

I. General information

NPI: 1497713119
Provider Name (Legal Business Name): LISA MARIE LITCHFORD OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA MARIE MEYER OTR/L

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14055 TOWN LOOP BLVD SUITE 300
ORLANDO FL
32837-6105
US

IV. Provider business mailing address

130 INTEGRA VILLAGE TRL APT 340
SANFORD FL
32771-9322
US

V. Phone/Fax

Practice location:
  • Phone: 407-857-6285
  • Fax: 407-857-9566
Mailing address:
  • Phone: 904-728-7402
  • Fax: 407-857-9566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: