Individual provider Active NPI

Lisa M Harrison

  • Occupational Therapy Assistant
  • Palm Coast, FL
National Provider Identifier
1164020095
Registry record updated Oct 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
OTA15358 Issued in FL
Practice address
83 Pepperdine Dr
Palm Coast, FL 32164-7498
Phone
(386) 793-3159
NPI assigned
Oct 13, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X OTA046825 AZ
Occupational Therapy Assistant 224Z00000X OTA3726 MS
Occupational Therapy Assistant 224Z00000X OTA4227 NM
Occupational Therapy Assistant 224Z00000X 46TA09186500 NJ
Occupational Therapy Assistant 224Z00000X 214087 TX
Occupational Therapy Assistant 224Z00000X 4394 AL
Occupational Therapy Assistant 224Z00000X OTA15358 FL Primary

Addresses

Primary practice location

83 Pepperdine Dr
Palm Coast, FL 32164-7498

Mailing address

PO Box 353842
Palm Coast, FL 32135-3842
Phone (386) 793-3159

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
OTA046825AZMDOccupational Therapy Assistant
OTA15358FLMDOccupational Therapy Assistant
OTA3726MSMDOccupational Therapy Assistant
46TA09186500NJMDOccupational Therapy Assistant
OTA4227NMMDOccupational Therapy Assistant
214087TXMDOccupational Therapy Assistant
4394ALMDSpeech-Language Pathologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602547200000",
    "number": "1164020095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 353842",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321353842",
            "telephone_number": "386-793-3159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "83 PEPPERDINE DR",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321647498",
            "telephone_number": "386-793-3159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRISON",
        "first_name": "LISA",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-13",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "AZ",
            "license": "OTA046825",
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MS",
            "license": "OTA3726",
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "NM",
            "license": "OTA4227",
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "NJ",
            "license": "46TA09186500",
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "TX",
            "license": "214087",
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "AL",
            "license": "4394",
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "FL",
            "license": "OTA15358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Coast, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.