Lisa Beth Wade
Occupational Therapist - Gerontology
6901 N Galena Rd
Peoria
, Illinois 61614-3193
Lisa Beth Wade
Occupational Therapist - Gerontology
6901 N Galena Rd
Peoria
, Illinois 61614-3193
(309) 678-0363
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About
Features
Specialties
- Occupational Therapist - Gerontology
Languages spoken
- English
Location
First Address
- Lisa Beth Wade
- 318 E Craig St
- Princeville, IL
- Zip : 61559-9596
- Phone : (309) 678-0363
Second Address
- Lisa Beth Wade
- 6901 N Galena Rd
- Peoria, IL
- Zip : 61614-3193
- Phone : (309) 692-4600
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 225XG0600X | Occupational Therapist - Gerontology | 057000996 | IL |
National Provider Identifier
| NPI | 1003576083 |
|---|---|
| Provider Name | Lisa Beth Wade |
| First Address | Princeville, IL 61559-9596 |
| Second Address | Peoria, IL 61614-3193 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 18/12/2021 |
| Last Update Date | 18/12/2021 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.