MEDICARE: MRS. LISA MARIE FLANAGAN OTR/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	225X00000X	Occupational Therapist		WI

General Provider Information

NPI Number	:	1194378224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA MARIE FLANAGAN OTR/L

Provider Business Mailing Address
First Line	:	1700 CARRIE AVE
Second Line	:
City	:	RICE LAKE
State	:	WI
Zip	:	54868-3064
Country	:	US
Telephone Number	:	715-234-9007
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 PHIPPS AVE
Second Line	:
City	:	RICE LAKE
State	:	WI
Zip	:	54868-1996
Country	:	US
Telephone Number	:	715-234-9007
Fax Number	:

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

Provider Enumeration Date	:	07/17/2019
Last Update Date	:	05/29/2026

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