Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0200X | Occupational Therapist - Pediatrics | 04483 | MD |
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT987 | DC |
NPI | 1003275686 |
---|---|
Provider Name | Lisa George |
First Address | Columbia, MD 21044-6026 |
Second Address | Washington, DC 20015-2113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2016 |
Last Update Date | 11/02/2016 |