Provider Demographics
NPI:1730227604
Name:COOSEMAN, LISA M (OTRL, MS)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:COOSEMAN
Suffix:
Gender:F
Credentials:OTRL, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:324 JUNGERMANN RD.
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376
Mailing Address - Country:US
Mailing Address - Phone:636-928-5327
Mailing Address - Fax:636-928-5322
Practice Address - Street 1:324 JUNGERMANN RD.
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376
Practice Address - Country:US
Practice Address - Phone:636-928-5327
Practice Address - Fax:636-928-5322
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000161764225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics