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General NPI Number Information
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NPI Number | 1184226490
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Entity Type | Organization
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Legal Business Name | LIFESTYLE TRANSITIONS, PLLC
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Dates
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Enumeration Date | 11/11/2020
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Last Update Date | 03/17/2024
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Provider Practice Location Address
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Address Line | 9328 WOOD DUCK DR
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City | FORT WORTH
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State | TX
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Zip | 76118-7784
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Country | US
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Telephone | 817-891-3255
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Fax | 682-253-2366
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Provider Business Mailing Address
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Address Line | 9328 WOOD DUCK DR
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City | FORT WORTH
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State | TX
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Zip | 76118-7784
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Country | US
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Telephone | 682-253-2366
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Fax | 817-537-2510
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LISA MICHELLE HOLLOWAY
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Credential | OT
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Telephone | 817-891-3255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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