Provider Demographics
NPI:1679169346
Name:CARR, LISA DEVERE (OTR/L)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:DEVERE
Last Name:CARR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 OVERLOOK CIR
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-7212
Mailing Address - Country:US
Mailing Address - Phone:678-520-7291
Mailing Address - Fax:
Practice Address - Street 1:164 NURSING HOME CIR
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3117
Practice Address - Country:US
Practice Address - Phone:706-745-4948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5521225X00000X
NC3888225X00000X
FL20090225X00000X
FL3888225X00000X
GAOT004384225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist