Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 0119005726 | VA |
NPI | 1063894962 |
---|---|
Provider Name | Hallie Lifson |
First Address | Richmond, VA 23229-5009 |
Second Address | Richmond, VA 23221-3701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2015 |
Last Update Date | 26/06/2015 |