Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 2890 | AZ |
NPI | 1134210685 |
---|---|
Provider Name | Lisa Harris Jordan |
First Address | Gilbert, AZ 85234-2168 |
Second Address | Gilbert, AZ 85234-2168 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 03/02/2017 |