MEDICARE: LISA MICHELLE HALLER-BENT COTA/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	OTA2443	OH

General Provider Information

NPI Number	:	1144038167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MICHELLE HALLER-BENT COTA/L

Provider Business Mailing Address
First Line	:	284 TAUBER DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458-2214
Country	:	US
Telephone Number	:	937-212-7195
Fax Number	:

Provider Business Practice Location Address
First Line	:	7383 PARAGON RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45459-4119
Country	:	US
Telephone Number	:	937-212-7195
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2024
Last Update Date	:	12/23/2024

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