Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | OTH-000831 | AZ |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OTH-000831 | AZ |
NPI | 1154072767 |
---|---|
Provider Name | Lisa Walters |
First Address | Tucson, AZ 85704-4718 |
Second Address | Tucson, AZ 85705-1764 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2022 |
Last Update Date | 14/01/2022 |