Lisa Wilson

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

217536 Issued in TX

Practice address

14673 Midway Rd Ste 1-111
Addison, TX 75001-3171

Phone

(972) 851-1022

NPI assigned

Aug 15, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lisa Pope Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sanctum Health Partners, LLC

  • Home Health Agency
  • Carrollton, TX
  • NPI 1598254989
  NPD (past)

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

{
    "created_epoch": "1660521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660521600000",
    "number": "1376271569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10341 SHADOW VALLEY CT",
            "city": "BURLESON",
            "state": "TX",
            "postal_code": "760280181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14673 MIDWAY RD STE 1-111",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750013171",
            "telephone_number": "972-851-1022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "LISA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-15",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapy Assistant",
            "state": "TX",
            "license": "217536",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4696826774",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "SHP",
            "affiliation": "N",
            "endpointDescription": "SHP",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "14673 Midway Rd Ste 1-111",
            "city": "Addison",
            "state": "TX",
            "country_code": "US",
            "postal_code": "750013171",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "POPE",
            "credential": "COTA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Charleen Wilder
• Alesha Lizzette Williams, LPC
• Willowbend Interventional Pain Center, LLC
• Emily Paige Wilson, M.S., CCC-SLP
• Katherine McMillan Wilson, LPC
• Tina E Wilson, LCSW
• Windhaven Interventional Pain Center, LLC
• Summer Wintersteen
• Melissa Worley, LPC-ASSOCIATE, M.ED
• Marguerite Giuliani Wuebker, M.D.

• Occupational Therapy Assistant in Addison, TX
• Providers in Addison, TX by specialty
• Occupational Therapy Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; 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.