Healthcare Provider Details

I. General information

NPI: 1811043375
Provider Name (Legal Business Name): LISA WHITTENTON OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1289 OLIVER ST
FAYETTEVILLE NC
28304-4450
US

IV. Provider business mailing address

494 WINDWOOD ON SKYE
FAYETTEVILLE NC
28303-4777
US

V. Phone/Fax

Practice location:
  • Phone: 910-483-8331
  • Fax: 910-483-8335
Mailing address:
  • Phone: 910-323-3077
  • Fax: 910-483-8335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: