Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 5894 | MA |
NPI | 1073799680 |
---|---|
Provider Name | Lisa Williamson |
First Address | Hyannis, MA 02601-3922 |
Second Address | Hyannis, MA 02601-3922 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2008 |
Last Update Date | 14/01/2008 |