Provider Demographics
NPI:1144038167
Name:HALLER-BENT, LISA MICHELLE (COTA/L)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:HALLER-BENT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 TAUBER DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-2214
Mailing Address - Country:US
Mailing Address - Phone:937-212-7195
Mailing Address - Fax:
Practice Address - Street 1:7383 PARAGON RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4119
Practice Address - Country:US
Practice Address - Phone:937-212-7195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA2443224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant