Provider Demographics
NPI:1629506431
Name:WOODING, LISA GRAVES (OTD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:GRAVES
Last Name:WOODING
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:4510 PREMIER DR
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8193
Practice Address - Country:US
Practice Address - Phone:336-568-6122
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11891225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist