Healthcare Provider Details

I. General information

NPI: 1699826925
Provider Name (Legal Business Name): LISA M STEVENS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10587 DOUBLE R BLVD 101
RENO NV
89521-8909
US

IV. Provider business mailing address

1805 DESERT MOUNTAIN DR
SPARKS NV
89436-7624
US

V. Phone/Fax

Practice location:
  • Phone: 775-324-5371
  • Fax: 775-852-5373
Mailing address:
  • Phone: 775-626-3442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0097
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: