Individual
LISA STARK-JONES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
1142 ORLANDO DR, DE PERE, WI 54115-9484
(920) 339-0700
(920) 330-0278
Mailing address
2680 FOXFIRE DR, GREEN BAY, WI 54311-6790
(920) 469-3546
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
286-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40739300
—
WI
Enumeration date
03/21/2007
Last updated
07/08/2007
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