MEDICARE: LIFESTYLE TRANSITIONS, PLLC

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	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1184226490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESTYLE TRANSITIONS, PLLC

Provider Business Mailing Address
First Line	:	9328 WOOD DUCK DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76118-7784
Country	:	US
Telephone Number	:	682-253-2366
Fax Number	:	817-537-2510

Provider Business Practice Location Address
First Line	:	9328 WOOD DUCK DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76118-7784
Country	:	US
Telephone Number	:	817-891-3255
Fax Number	:	682-253-2366

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LISA MICHELLE HOLLOWAY
Credential	:	OT
Telephone Number	:	817-891-3255

Provider Enumeration Date	:	11/11/2020
Last Update Date	:	03/17/2024

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