Provider Demographics
NPI:1174553507
Name:MARSHALL, LISA MARIE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 E MAIN ST
Mailing Address - Street 2:SUITE 132
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7333
Mailing Address - Country:US
Mailing Address - Phone:302-709-0440
Mailing Address - Fax:302-709-0443
Practice Address - Street 1:280 E MAIN ST
Practice Address - Street 2:SUITE 132
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7333
Practice Address - Country:US
Practice Address - Phone:302-709-0440
Practice Address - Fax:302-709-0443
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU1-0000146225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000035510Medicaid
DE00B327S65Medicare PIN