Healthcare Provider Details

I. General information

NPI: 1811252562
Provider Name (Legal Business Name): LISA EBEYER MILLICAN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5559 CANAL BLVD.
NEW ORLEANS LA
70124-2745
US

IV. Provider business mailing address

5559 CANAL BLVD.
NEW ORLEANS LA
70124-2745
US

V. Phone/Fax

Practice location:
  • Phone: 504-235-6759
  • Fax: 504-835-8276
Mailing address:
  • Phone: 504-235-6759
  • Fax: 504-835-8276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberZ10969
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License NumberZ10969
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License NumberZ10969
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License NumberZ10969
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberZ10969
License Number StateLA
# 6
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberZ10969
License Number StateLA
# 7
Primary TaxonomyN
Taxonomy Code225XH1300X
TaxonomyHuman Factors Occupational Therapist
License NumberZ10969
License Number StateLA
# 8
Primary TaxonomyN
Taxonomy Code225XL0004X
TaxonomyLow Vision Occupational Therapist
License NumberZ10969
License Number StateLA
# 9
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License NumberZ10969
License Number StateLA
# 10
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberZ10969
License Number StateLA
# 11
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberZ10969
License Number StateLA
# 12
Primary TaxonomyN
Taxonomy Code225XR0403X
TaxonomyDriving and Community Mobility Occupational Therapist
License NumberZ10969
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: