Lisa L Owens

Key facts

NPI

1154873339

Entity type

Individual (NPI type 1)

Primary specialty

Occupational Therapist 225X00000X

License

OT-792 (ID)

Practice address

220 S Division Ave
Sandpoint, ID 83864-1759

Phone

(208) 265-4514

NPI assigned

Nov 3, 2016

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 3, 2016.

{
    "created_epoch": "1478131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478131200000",
    "number": "1154873339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 S BOYER AVE",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838641101",
            "telephone_number": "208-699-9635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 S DIVISION AVE",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838641759",
            "telephone_number": "208-265-4514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OWENS",
        "first_name": "LISA",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-03",
        "last_updated": "2016-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "ID",
            "license": "OT-792",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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