Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 005155 | MO |
NPI | 1073668885 |
---|---|
Provider Name | Mrs. Lisa Anne Traynor |
First Address | Troy, MO 63379-5610 |
Second Address | Troy, MO 63379-5610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 08/07/2007 |