Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA.006864 | OH |
NPI | 1023531464 |
---|---|
Provider Name | Lisa Ann Martin |
First Address | North Ridgeville, OH 44039-5300 |
Second Address | North Canton, OH 44720-2593 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2017 |
Last Update Date | 18/07/2017 |