Provider Demographics
NPI:1770547812
Name:BRIECHLE-REESE, LISA M (OT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:BRIECHLE-REESE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:BRIECHLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:2917 MAIN STREET UNIT 311
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214
Mailing Address - Country:US
Mailing Address - Phone:716-445-2369
Mailing Address - Fax:
Practice Address - Street 1:2917 MAIN STREET UNIT 311
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214
Practice Address - Country:US
Practice Address - Phone:716-445-2369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02227461Medicaid
NY000670109001OtherBLUE CROSS BLUE SHIELD
NY040426003652OtherFIDELIS
NY9611520OtherIHA
NY838766OtherMANAGED PHYSICAL NETWORK
NY00011174501OtherUNIVERA
NY670002134OtherRR MEDICARE
NY838766OtherMANAGED PHYSICAL NETWORK
NY670002134OtherRR MEDICARE