Active NPI
Lisa Wallace, OT
- Occupational Therapist
- Austin, TX
National Provider Identifier
1417365016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 108673
- Practice address
- 1215 Red River St
Austin, TX 78701-1921 - Phone
- (512) 324-7131
- NPI assigned
- Jul 27, 2014
- Last updated
- Jul 27, 2014
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 108673 | TX | Primary |
Addresses
Primary practice location
1215 Red River St
Austin, TX 78701-1921
Mailing address
1400 N Ih 35
Suite 300
Austin, TX 78701-1926
Phone (512) 324-8300
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 108673 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1406419200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1406419200000",
"number": "1417365016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 N IH 35",
"address_2": "SUITE 300",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787011926",
"telephone_number": "512-324-8300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1215 RED RIVER ST",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787011921",
"telephone_number": "512-324-7131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "LISA",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-07-27",
"last_updated": "2014-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "108673",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.