Active NPI
Lisa Stulgate, COTA/L
- Occupational Therapy Assistant
- Glenview, IL
National Provider Identifier
1588035893
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 057003616
- Practice address
- 3703 West Lake Avenue Suite 200
Glenview, IL 60026-1223 - Phone
- (847) 998-1188
- NPI assigned
- Oct 13, 2015
- 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 Therapy Assistant | 224Z00000X | 057003616 | IL | Primary |
Addresses
Primary practice location
3703 West Lake Avenue Suite 200
Glenview, IL 60026-1223
Mailing address
5659 Mill Trace Drive
Dunwoody, GA 30338
Phone (214) 801-0915
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 |
|---|---|---|---|
| 057003616 | IL | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1444694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444694400000",
"number": "1588035893",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5659 MILL TRACE DRIVE",
"city": "DUNWOODY",
"state": "GA",
"postal_code": "30338",
"telephone_number": "214-801-0915"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3703 WEST LAKE AVENUE SUITE 200",
"city": "GLENVIEW",
"state": "IL",
"postal_code": "600261223",
"telephone_number": "847-998-1188"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STULGATE",
"first_name": "LISA",
"credential": "COTA/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-10-13",
"last_updated": "2015-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "IL",
"license": "057003616",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glenview, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.