MEDICARE: LISA COUGHENOUR

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	373H00000X	Day Training/Habilitation Specialist		OH

General Provider Information

NPI Number	:	1740124510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA COUGHENOUR

Provider Business Mailing Address
First Line	:	7801 PROUTY RD
Second Line	:
City	:	LODI
State	:	OH
Zip	:	44254-9614
Country	:	US
Telephone Number	:	330-933-4795
Fax Number	:

Provider Business Practice Location Address
First Line	:	2215 E WATERLOO RD STE 104
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44312-3818
Country	:	US
Telephone Number	:	330-933-4795
Fax Number	:

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

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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Directions to “ LISA COUGHENOUR ” Practice Location

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