Active NPI
Lisa M Harrison
- Occupational Therapy Assistant
- Palm Coast, FL
National Provider Identifier
1164020095
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- OTA15358
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| OTA046825 | AZ | MD | Occupational Therapy Assistant |
| OTA15358 | FL | MD | Occupational Therapy Assistant |
| OTA3726 | MS | MD | Occupational Therapy Assistant |
| 46TA09186500 | NJ | MD | Occupational Therapy Assistant |
| OTA4227 | NM | MD | Occupational Therapy Assistant |
| 214087 | TX | MD | Occupational Therapy Assistant |
| 4394 | AL | MD | Speech-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.