Healthcare Provider Details

I. General information

NPI: 1639542137
Provider Name (Legal Business Name): LISA MONJEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA HEWITT

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 2ND AVE N APT 203
NASHVILLE TN
37208-1780
US

IV. Provider business mailing address

48 PLEASANT ST
UPTON MA
01568-1430
US

V. Phone/Fax

Practice location:
  • Phone: 774-214-8498
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number11784
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: