Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 8700 | MA |
N | 225XP0200X | Occupational Therapist - Pediatrics | 8700 | MA |
NPI | 1033355375 |
---|---|
Provider Name | Mrs. Lisa Ann Crounse |
First Address | Somerville, MA 02143-1308 |
Second Address | Somerville, MA 02143-1308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2008 |
Last Update Date | 16/12/2008 |