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General NPI Number Information
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NPI Number | 1073128070
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Entity Type | Individual
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Provider Name | LISA MARIE LEMKE OTRL
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Gender | Female
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Dates
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Enumeration Date | 09/15/2020
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Last Update Date | 09/15/2020
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Provider Practice Location Address
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Address Line | 4489 M 61 STE 6
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City | STANDISH
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State | MI
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Zip | 48658-9272
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Country | US
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Telephone | 989-718-3171
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Fax |
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Provider Business Mailing Address
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Address Line | 2231 PARISH RD
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City | KAWKAWLIN
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State | MI
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Zip | 48631-9416
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Country | US
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Telephone | 989-928-0504
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224ZE0001X
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Taxonomy Name | Environmental Modification Occupational Therapy Assistant
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License Number | 5201002199
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License Number State | MI
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