Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT 60279870 | WA |
N | 225XG0600X | Occupational Therapist - Gerontology | OT 60279870 | WA |
N | 2251H1300X | Human Factors | OT 60279870 | WA |
N | 225XH1300X | Human Factors | OT 60279870 | WA |
N | 225XM0800X | Mental Health | OT 60279870 | WA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT 60279870 | WA |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT 60279870 | WA |
NPI | 1477982288 |
---|---|
Provider Name | Mrs. Lisa Ann Edwards |
First Address | Federal Way, WA 98003-4706 |
Second Address | Federal Way, WA 98003-4706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2013 |
Last Update Date | 02/11/2013 |