Healthcare Provider Details

I. General information

NPI: 1861343535
Provider Name (Legal Business Name): LISA NEWBOLD OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2026
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HALL PL
GROSSE POINTE FARMS MI
48236-3807
US

IV. Provider business mailing address

120 HALL PL
GROSSE POINTE FARMS MI
48236-3807
US

V. Phone/Fax

Practice location:
  • Phone: 616-914-2007
  • Fax:
Mailing address:
  • Phone: 616-914-2007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201007671
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: