Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 015902-1 | NY |
NPI | 1871836452 |
---|---|
Provider Name | Lisa Marie Foundas |
First Address | Kings Park, NY 11754-1304 |
Second Address | Kings Park, NY 11754-1304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2013 |
Last Update Date | 21/05/2018 |