Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT16797 | FL |
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT16797 | FL |
NPI | 1073077343 |
---|---|
Provider Name | Lisa Marlene Thompson-Goertz |
First Address | Ocala, FL 34471-2775 |
Second Address | Ocala, FL 34481-7848 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2019 |
Last Update Date | 03/01/2021 |