Active NPI
Lisa Kathleen Moreno, OTR/L, CHT, PAMS
- Occupational Therapist
- San Luis Obispo, CA
National Provider Identifier
1407119993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 2565
- Practice address
- 187 Tank Farm Rd
Suite 220
San Luis Obispo, CA 93401-7081 - Phone
- (905) 545-8699
- NPI assigned
- Jun 19, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 2565 | CA | Primary |
Addresses
Primary practice location
187 Tank Farm Rd
Suite 220
San Luis Obispo, CA 93401-7081
Mailing address
187 Tank Farm Rd.
Suite 220
San Luis Obispo, CA 93401
Phone (905) 545-8699
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 |
|---|---|---|---|
| 2565 | CA | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340064000000",
"number": "1407119993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "187 TANK FARM RD.",
"address_2": "SUITE 220",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "93401",
"telephone_number": "905-545-8699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "187 TANK FARM RD",
"address_2": "SUITE 220",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934017081",
"telephone_number": "905-545-8699"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORENO",
"first_name": "LISA",
"middle_name": "KATHLEEN",
"name_prefix": "Mrs.",
"credential": "OTR/L, CHT, PAMS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-06-19",
"last_updated": "2012-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "2565",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Luis Obispo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.