Lisa Marie Mangelsdorff, COTA/L
Individual provider Active NPI Occupational Therapy Assistant · Midlothian, IL
NPI 1891935136 · NPPES record last updated Feb 26, 2009
Key facts
- NPI
- 1891935136
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 057-001348 (IL)
- Practice address
- 14520 Hamlin Ave
Midlothian, IL 60445-2816 - Phone
- (708) 925-9922
- NPI assigned
- Feb 26, 2009
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 057-001348 | IL | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 057-001348 | IL | Yes |
Addresses
Primary practice location
14520 Hamlin Ave
Midlothian, IL 60445-2816
Mailing address
14520 Hamlin Ave
Midlothian, IL 60445-2816
Phone (708) 925-9922
Other providers in Midlothian, IL
- Lacy Carol Little
- Ruben Manuel Lopez III
- Elizabeth Lynch
- Marcia Mabin
- Dayra Melissa Macias
- Karina Martinez
- Elizabeth C McCarthy
- Ellen Meyers-Hafner
- Midlothian Family Dental LTD.
- Midlothian School Ditrict 143
All providers in Midlothian, IL · Occupational Therapy Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.