Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 9390 | NC |
NPI | 1003218462 |
---|---|
Provider Name | Adam Peter Lisewski |
First Address | Fayetteville, NC 28304-2682 |
Second Address | Fayetteville, NC 28304-4450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2014 |
Last Update Date | 17/09/2014 |