Individual
MRS. LISA C STEVENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
45 MERIDEN AVE, SOUTHINGTON, CT 06489-3214
(860) 378-1234
(860) 378-1160
Mailing address
78 PEPPERIDGE DR, SOUTHINGTON, CT 06489-4416
(860) 620-0476
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
001292
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001292
CT LICENSE
CT
01
—
130001292CT01
ANTHEM BLUE CROSS
CT
Enumeration date
06/07/2007
Last updated
07/08/2007
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