Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224Z00000X | Occupational Therapy Assistant | 4998 | NC |
Y | 224Z00000X | Occupational Therapy Assistant | OP006627 | PA |
NPI | 1013169655 |
---|---|
Provider Name | Mrs. Lisa Jane Edwards |
First Address | Boothwyn, PA 19061-2742 |
Second Address | Ridley Park, PA 19078-2409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2008 |
Last Update Date | 14/10/2008 |