Provider Demographics
NPI:1598831711
Name:BRANSCUM, LISA ANN (OTR)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:BRANSCUM
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:WICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1499 6TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-2365
Mailing Address - Country:US
Mailing Address - Phone:863-293-7778
Mailing Address - Fax:863-299-3836
Practice Address - Street 1:1499 6TH ST NW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-2365
Practice Address - Country:US
Practice Address - Phone:863-293-7778
Practice Address - Fax:863-299-3836
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002976A225X00000X
FLOT26593225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist