Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251E1200X | Ergonomics | 3505 | OR |
Y | 225XE1200X | Ergonomics | 3505 | OR |
NPI | 1033454442 |
---|---|
Provider Name | Mrs. Lisa Ann Sevcik |
First Address | Portland, OR 97212-5131 |
Second Address | Portland, OR 97212-5131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2012 |
Last Update Date | 11/12/2012 |