Healthcare Provider Details

I. General information

NPI: 1144633231
Provider Name (Legal Business Name): LISA LYERLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3639 WINDLEWOOD DR
KATY TX
77449-6135
US

IV. Provider business mailing address

3639 WINDLEWOOD DR
KATY TX
77449-6135
US

V. Phone/Fax

Practice location:
  • Phone: 214-466-1340
  • Fax:
Mailing address:
  • Phone: 262-391-8666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number210614
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: